|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna American Axle |
$36.29
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| 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: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.9 % PROCESSING SOLUTION
|
Facility
|
IP
|
$101.70
|
|
|
Service Code
|
NDC 0338-0047-47
|
| Hospital Charge Code |
300288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$91.53 |
| Rate for Payer: Aetna American Axle |
$66.10
|
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.10
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cofinity Commercial |
$71.19
|
| Rate for Payer: Cofinity Commercial |
$87.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.36
|
| Rate for Payer: Healthscope Commercial |
$91.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.44
|
| Rate for Payer: PHP Commercial |
$86.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$64.07
|
| Rate for Payer: UMR Bronson Commercial |
$44.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.28
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 0223-1760-01
|
| Hospital Charge Code |
94158
|
|
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 CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 904723961
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 487900330
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 9900-0010-25
|
| Hospital Charge Code |
7321
|
|
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 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0054-03
|
| Hospital Charge Code |
7321
|
|
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 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$103.50
|
|
|
Service Code
|
NDC 63323-187-30
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Aetna American Axle |
$67.28
|
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.28
|
| Rate for Payer: BCBS Complete |
$41.40
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cofinity Commercial |
$72.45
|
| Rate for Payer: Cofinity Commercial |
$89.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.80
|
| Rate for Payer: Healthscope Commercial |
$93.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.98
|
| Rate for Payer: PHP Commercial |
$87.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health SBD |
$65.20
|
| Rate for Payer: UMR Bronson Commercial |
$38.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.62
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 63323-095-61
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$283.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.75
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.50
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UMR Bronson Commercial |
$138.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
NDC 63323-099-03
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna American Axle |
$578.50
|
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.50
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$623.00
|
| Rate for Payer: Cofinity Commercial |
$765.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.00
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.50
|
| Rate for Payer: PHP Commercial |
$756.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health SBD |
$560.70
|
| Rate for Payer: UMR Bronson Commercial |
$391.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 0409-1141-02
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.62
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.75
|
| Rate for Payer: Priority Health SBD |
$45.68
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
NDC 63323-093-01
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna American Axle |
$101.40
|
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UMR Bronson Commercial |
$68.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
NDC 63323-088-61
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
NDC 63323-093-30
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna American Axle |
$101.40
|
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UMR Bronson Commercial |
$68.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
NDC 63323-088-63
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$273.80 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna American Axle |
$481.00
|
| Rate for Payer: Aetna Commercial |
$629.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.00
|
| Rate for Payer: BCBS Complete |
$296.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cofinity Commercial |
$518.00
|
| Rate for Payer: Cofinity Commercial |
$636.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.00
|
| Rate for Payer: Healthscope Commercial |
$666.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.00
|
| Rate for Payer: PHP Commercial |
$629.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.00
|
| Rate for Payer: Priority Health SBD |
$466.20
|
| Rate for Payer: UMR Bronson Commercial |
$273.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.00
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 63323-095-02
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.00
|
| Rate for Payer: Healthscope Commercial |
$283.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.75
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.50
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UMR Bronson Commercial |
$138.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
NDC 63323-099-63
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna American Axle |
$578.50
|
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.50
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$623.00
|
| Rate for Payer: Cofinity Commercial |
$765.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.00
|
| Rate for Payer: Healthscope Commercial |
$801.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.50
|
| Rate for Payer: PHP Commercial |
$756.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health SBD |
$560.70
|
| Rate for Payer: UMR Bronson Commercial |
$391.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 9900-0019-15
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna American Axle |
$47.12
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Commercial |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.62
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.75
|
| Rate for Payer: Priority Health SBD |
$45.68
|
| Rate for Payer: UMR Bronson Commercial |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.38
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 9900-0000-98
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna American Axle |
$1.09
|
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.09
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.43
|
| Rate for Payer: PHP Commercial |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health SBD |
$1.06
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.26
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$60.55
|
|
|
Service Code
|
NDC 4843321501
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Aetna American Axle |
$39.36
|
| Rate for Payer: Aetna Commercial |
$51.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.36
|
| Rate for Payer: Cash Price |
$48.44
|
| Rate for Payer: Cofinity Commercial |
$42.38
|
| Rate for Payer: Cofinity Commercial |
$52.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$54.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.47
|
| Rate for Payer: PHP Commercial |
$51.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.38
|
| Rate for Payer: Priority Health SBD |
$38.15
|
| Rate for Payer: UMR Bronson Commercial |
$26.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.41
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$53.93
|
|
|
Service Code
|
NDC 536137785
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$48.54 |
| Rate for Payer: Aetna American Axle |
$35.05
|
| Rate for Payer: Aetna Commercial |
$45.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$37.75
|
| Rate for Payer: Cofinity Commercial |
$46.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Healthscope Commercial |
$48.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.84
|
| Rate for Payer: PHP Commercial |
$45.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.75
|
| Rate for Payer: Priority Health SBD |
$33.98
|
| Rate for Payer: UMR Bronson Commercial |
$23.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.45
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 487900760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna American Axle |
$1.76
|
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health SBD |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
NDC 5019014123
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna American Axle |
$1.84
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.84
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.98
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 8349020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.77
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.11
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.16
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
