|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| 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 Medicare |
$34.96
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| 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
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 00338004303
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.67
|
| Rate for Payer: UHC Core |
$35.01
|
| Rate for Payer: UHC Exchange |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 338004304
|
| 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 Medicare |
$34.96
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| 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 00338004303
|
| 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 Advantage |
$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 Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| 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 00338004304
|
| 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 Advantage |
$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 Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 264780200
|
| 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 Medicare |
$23.93
|
| 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 Advantage |
$33.49
|
| 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 |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
SODIUM CHLORIDE 0.45 % IV ADDITIONAL SOLUTION
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 00338004303
|
| 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 Advantage |
$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 Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| 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
|
$67.19
|
|
|
Service Code
|
NDC 00338004303
|
| Hospital Charge Code |
200165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.67
|
| Rate for Payer: UHC Core |
$35.01
|
| Rate for Payer: UHC Exchange |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 00338004303
|
| Hospital Charge Code |
400292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.67
|
| Rate for Payer: UHC Core |
$35.01
|
| Rate for Payer: UHC Exchange |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 00338004303
|
| 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 Advantage |
$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 Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| 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 00338004304
|
| 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 Advantage |
$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 Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
400292
|
|
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 Medicare |
$34.96
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna American Axle |
$4.21
|
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.21
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Advantage |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health SBD |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.21
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Exchange |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
NDC 00536250676
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Aetna American Axle |
$4.29
|
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.29
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cofinity Advantage |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$5.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.28
|
| Rate for Payer: Healthscope Commercial |
$5.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.61
|
| Rate for Payer: Priority Health SBD |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.29
|
| Rate for Payer: UHC Core |
$3.44
|
| Rate for Payer: UHC Exchange |
$2.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.95
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna American Axle |
$4.21
|
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.21
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Advantage |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health SBD |
$4.08
|
| Rate for Payer: UMR Bronson Commercial |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.86
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$2.43
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Advantage |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.56
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.95
|
| Rate for Payer: UHC Core |
$3.17
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
NDC 00536250676
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: Aetna American Axle |
$4.29
|
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.29
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cofinity Advantage |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$5.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.28
|
| Rate for Payer: Healthscope Commercial |
$5.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.61
|
| Rate for Payer: Priority Health SBD |
$4.16
|
| Rate for Payer: UMR Bronson Commercial |
$2.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.95
|
|
|
SODIUM CHLORIDE 0.9 % CONTINUOUS NEBULIZATION SOLUTION
|
Facility
|
OP
|
$41.46
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
200035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna American Axle |
$26.95
|
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.95
|
| Rate for Payer: BCBS Complete |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Advantage |
$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 |
$31.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.09
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: Priority Health SBD |
$26.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Exchange |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.09
|
|
|
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 Advantage |
$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 |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.09
|
| Rate for Payer: PHP Commercial |
$35.24
|
| 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 |
$31.09
|
|
|
SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| 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: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Exchange |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
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 Advantage |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| 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 Commercial |
$45.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: PHP Commercial |
$45.69
|
| 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
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
158683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.28
|
| Rate for Payer: UHC Core |
$3.28
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
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 Advantage |
$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 Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Advantage |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.86
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.61
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.86
|
|
