|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 64980-528-10
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 0536-1047-10
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 0904-7261-61
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$40.28
|
|
|
Service Code
|
NDC 0409-6637-34
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna American Axle |
$26.18
|
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.18
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health SBD |
$25.38
|
| Rate for Payer: UMR Bronson Commercial |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
IP
|
$40.28
|
|
|
Service Code
|
NDC 0409-6637-34
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna American Axle |
$26.18
|
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.18
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health SBD |
$25.38
|
| Rate for Payer: UMR Bronson Commercial |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SODIUM BICARBONATE (BULK) POWDER
|
Facility
|
IP
|
$58.31
|
|
|
Service Code
|
NDC 395268594
|
| Hospital Charge Code |
7310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$52.48 |
| Rate for Payer: Aetna American Axle |
$37.90
|
| Rate for Payer: Aetna Commercial |
$49.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.90
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Cofinity Commercial |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$50.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.65
|
| Rate for Payer: Healthscope Commercial |
$52.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.56
|
| Rate for Payer: PHP Commercial |
$49.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.82
|
| Rate for Payer: Priority Health SBD |
$36.74
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.73
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0043-04
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 0338-0043-03
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0043-04
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.45 % IV ADDITIONAL SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 0338-0043-03
|
| Hospital Charge Code |
200165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % IV ADDITIONAL SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 0264-7802-00
|
| Hospital Charge Code |
200165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 0338-0043-03
|
| Hospital Charge Code |
400292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0043-04
|
| Hospital Charge Code |
400292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$5.94
|
|
|
Service Code
|
NDC 45802-357-58
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna American Axle |
$3.86
|
| Rate for Payer: Aetna Commercial |
$5.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.86
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cofinity Commercial |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$5.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$5.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.46
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 0904-3865-75
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna American Axle |
$3.43
|
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.43
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.49
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.70
|
| Rate for Payer: Priority Health SBD |
$3.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$7.13
|
|
|
Service Code
|
NDC 0536-2506-76
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna American Axle |
$4.63
|
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.63
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$6.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$6.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.06
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.99
|
| Rate for Payer: Priority Health SBD |
$4.49
|
| Rate for Payer: UMR Bronson Commercial |
$3.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.35
|
|
|
SODIUM CHLORIDE 0.9 % CONTINUOUS NEBULIZATION SOLUTION
|
Facility
|
IP
|
$41.46
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
200035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna American Axle |
$26.95
|
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.95
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Commercial |
$29.02
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.17
|
| Rate for Payer: Healthscope Commercial |
$37.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.24
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$26.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
SODIUM CHLORIDE 0.9 % FOR AMNIOINFUSION (OB)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
158683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 7620430050
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 7620430003
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 0378-6986-01
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
180423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 2X MAINTENANCE SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
300194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$41.47
|
|
|
Service Code
|
NDC 0338-0553-11
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
