|
SKIN ULCERS WITH CC
|
Facility
|
IP
|
$19,336.69
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$9,987.96 |
| Max. Negotiated Rate |
$19,336.69 |
| Rate for Payer: Aetna Medicare |
$10,934.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,142.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,142.05
|
| Rate for Payer: BCBS MAPPO |
$10,513.64
|
| Rate for Payer: BCBS Trust/PPO |
$17,373.74
|
| Rate for Payer: BCN Commercial |
$17,373.74
|
| Rate for Payer: BCN Medicare Advantage |
$10,513.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,513.64
|
| Rate for Payer: Mclaren Medicare |
$10,513.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,039.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,090.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,565.00
|
| Rate for Payer: Nomi Health Commercial |
$15,303.27
|
| Rate for Payer: PACE Medicare |
$9,987.96
|
| Rate for Payer: PACE SWMI |
$10,513.64
|
| Rate for Payer: PHP Medicare Advantage |
$10,513.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,125.69
|
| Rate for Payer: Priority Health Medicare |
$10,513.64
|
| Rate for Payer: Priority Health Tiered Network |
$15,300.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10,513.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,336.69
|
| Rate for Payer: UHC Core |
$16,177.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,513.64
|
| Rate for Payer: UHC Exchange |
$13,211.82
|
| Rate for Payer: VA VA |
$10,513.64
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$31,545.39
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$15,938.43 |
| Max. Negotiated Rate |
$31,545.39 |
| Rate for Payer: Aetna Medicare |
$17,448.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,971.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,971.61
|
| Rate for Payer: BCBS MAPPO |
$16,777.29
|
| Rate for Payer: BCBS Trust/PPO |
$29,133.75
|
| Rate for Payer: BCN Commercial |
$29,133.75
|
| Rate for Payer: BCN Medicare Advantage |
$16,777.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,777.29
|
| Rate for Payer: Mclaren Medicare |
$16,777.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,616.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,293.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,455.02
|
| Rate for Payer: Nomi Health Commercial |
$24,965.37
|
| Rate for Payer: PACE Medicare |
$15,938.43
|
| Rate for Payer: PACE SWMI |
$16,777.29
|
| Rate for Payer: PHP Medicare Advantage |
$16,777.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,201.18
|
| Rate for Payer: Priority Health Medicare |
$16,777.29
|
| Rate for Payer: Priority Health Tiered Network |
$24,960.94
|
| Rate for Payer: Railroad Medicare Medicare |
$16,777.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,545.39
|
| Rate for Payer: UHC Core |
$26,391.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,777.29
|
| Rate for Payer: UHC Exchange |
$21,553.44
|
| Rate for Payer: VA VA |
$16,777.29
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,128.84
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$7,449.68 |
| Max. Negotiated Rate |
$14,128.84 |
| Rate for Payer: Aetna Medicare |
$8,155.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,802.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,802.21
|
| Rate for Payer: BCBS MAPPO |
$7,841.77
|
| Rate for Payer: BCBS Trust/PPO |
$11,307.07
|
| Rate for Payer: BCN Commercial |
$11,307.07
|
| Rate for Payer: BCN Medicare Advantage |
$7,841.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,841.77
|
| Rate for Payer: Mclaren Medicare |
$7,841.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,233.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,018.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,625.95
|
| Rate for Payer: Nomi Health Commercial |
$11,181.72
|
| Rate for Payer: PACE Medicare |
$7,449.68
|
| Rate for Payer: PACE SWMI |
$7,841.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,841.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,974.67
|
| Rate for Payer: Priority Health Medicare |
$7,841.77
|
| Rate for Payer: Priority Health Tiered Network |
$11,179.74
|
| Rate for Payer: Railroad Medicare Medicare |
$7,841.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,128.84
|
| Rate for Payer: UHC Core |
$11,820.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,841.77
|
| Rate for Payer: UHC Exchange |
$9,653.55
|
| Rate for Payer: VA VA |
$7,841.77
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,692.15
|
| Rate for Payer: BCN Commercial |
$5,692.15
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
SOAP BAR
|
Facility
|
OP
|
$12.56
|
|
|
Service Code
|
NDC 70501001010
|
| Hospital Charge Code |
108564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna American Axle |
$8.16
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.16
|
| Rate for Payer: BCBS Complete |
$5.02
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Cofinity Advantage |
$8.79
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$11.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.42
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health SBD |
$7.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.16
|
| Rate for Payer: UHC Core |
$6.54
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UMR Bronson Commercial |
$4.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.42
|
|
|
SOAP BAR
|
Facility
|
IP
|
$12.56
|
|
|
Service Code
|
NDC 70501001010
|
| Hospital Charge Code |
108564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna American Axle |
$8.16
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.16
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Cofinity Advantage |
$8.79
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$11.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.42
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health SBD |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.42
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
OP
|
$42.01
|
|
|
Service Code
|
NDC 409577901
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna American Axle |
$27.31
|
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health SBD |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.31
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: UHC Exchange |
$16.51
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
IP
|
$42.01
|
|
|
Service Code
|
NDC 00409577901
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna American Axle |
$27.31
|
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health SBD |
$26.47
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
OP
|
$42.01
|
|
|
Service Code
|
NDC 00409577901
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna American Axle |
$27.31
|
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.31
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Advantage |
$29.41
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health SBD |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.31
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: UHC Exchange |
$16.51
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
NDC 00409329945
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$75.21
|
|
|
Service Code
|
NDC 69784023010
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$67.69 |
| Rate for Payer: Aetna American Axle |
$48.89
|
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.89
|
| Rate for Payer: Cash Price |
$60.17
|
| Rate for Payer: Cofinity Advantage |
$52.65
|
| Rate for Payer: Cofinity Commercial |
$64.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.17
|
| Rate for Payer: Healthscope Commercial |
$67.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.41
|
| Rate for Payer: PHP Commercial |
$63.93
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.41
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
NDC 00409329945
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC Core |
$12.75
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00409329916
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.07
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
NDC 00409329925
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.91
|
| Rate for Payer: UHC Core |
$12.75
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.07
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 69784023110
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
NDC 00409729925
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$18.78 |
| Rate for Payer: Aetna American Axle |
$13.57
|
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.57
|
| Rate for Payer: UHC Core |
$10.87
|
| Rate for Payer: UHC Exchange |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.65
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
NDC 00409329925
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
NDC 69784023110
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.31
|
| Rate for Payer: UHC Core |
$38.72
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$68.53
|
|
|
Service Code
|
NDC 69784023120
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Advantage |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.40
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00409329916
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
