|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| 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 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 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.04
|
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 63323009502
|
| 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 Advantage |
$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 Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| 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
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 63323009502
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.75
|
| Rate for Payer: UHC Core |
$164.12
|
| Rate for Payer: UHC Exchange |
$123.80
|
| Rate for Payer: UMR Bronson Commercial |
$116.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
NDC 63323008863
|
| 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 Medicare |
$370.00
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$592.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.00
|
| Rate for Payer: PHP Commercial |
$629.00
|
| Rate for Payer: Priority Health SBD |
$466.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.00
|
| Rate for Payer: UHC Core |
$385.54
|
| Rate for Payer: UHC Exchange |
$290.82
|
| 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
|
$630.00
|
|
|
Service Code
|
NDC 63323009903
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 00409114102
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$402.50
|
|
|
Service Code
|
NDC 00409114102
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.62
|
| Rate for Payer: UHC Core |
$209.70
|
| Rate for Payer: UHC Exchange |
$158.18
|
| Rate for Payer: UMR Bronson Commercial |
$148.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 63323009561
|
| 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 Advantage |
$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 Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| 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
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.04
|
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna Medicare |
$73.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.04
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: UHC Exchange |
$58.07
|
| Rate for Payer: UMR Bronson Commercial |
$54.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.04
|
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna Medicare |
$73.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.04
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: UHC Exchange |
$58.07
|
| Rate for Payer: UMR Bronson Commercial |
$54.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
NDC 63323009963
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.50
|
| Rate for Payer: UHC Core |
$328.23
|
| Rate for Payer: UHC Exchange |
$247.59
|
| Rate for Payer: UMR Bronson Commercial |
$233.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
NDC 63323009903
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.50
|
| Rate for Payer: UHC Core |
$328.23
|
| Rate for Payer: UHC Exchange |
$247.59
|
| Rate for Payer: UMR Bronson Commercial |
$233.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
NDC 63323009963
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.04
|
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 63323009561
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna American Axle |
$204.75
|
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.75
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.75
|
| Rate for Payer: UHC Core |
$164.12
|
| Rate for Payer: UHC Exchange |
$123.80
|
| Rate for Payer: UMR Bronson Commercial |
$116.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.25
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$402.50
|
|
|
Service Code
|
NDC 09900001915
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.62
|
| Rate for Payer: UHC Core |
$209.70
|
| Rate for Payer: UHC Exchange |
$158.18
|
| Rate for Payer: UMR Bronson Commercial |
$148.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 09900001915
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 09900000098
|
| 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 Advantage |
$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 Commercial |
$1.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.26
|
| Rate for Payer: PHP Commercial |
$1.43
|
| 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
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 09900000098
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna American Axle |
$1.09
|
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.09
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.26
|
| Rate for Payer: PHP Commercial |
$1.43
|
| Rate for Payer: Priority Health SBD |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.09
|
| Rate for Payer: UHC Core |
$0.88
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.26
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$54.87
|
|
|
Service Code
|
NDC 00536137785
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$49.38 |
| Rate for Payer: Aetna American Axle |
$35.67
|
| Rate for Payer: Aetna Commercial |
$46.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.67
|
| Rate for Payer: Cash Price |
$43.90
|
| Rate for Payer: Cofinity Advantage |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$47.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.90
|
| Rate for Payer: Healthscope Commercial |
$49.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.64
|
| Rate for Payer: Priority Health SBD |
$34.57
|
| Rate for Payer: UMR Bronson Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$65.75
|
|
|
Service Code
|
NDC 48433021501
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna American Axle |
$42.74
|
| Rate for Payer: Aetna Commercial |
$55.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.74
|
| Rate for Payer: Cash Price |
$52.60
|
| Rate for Payer: Cofinity Advantage |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$56.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.60
|
| Rate for Payer: Healthscope Commercial |
$59.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.31
|
| Rate for Payer: PHP Commercial |
$55.89
|
| Rate for Payer: Priority Health SBD |
$41.42
|
| Rate for Payer: UMR Bronson Commercial |
$28.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.31
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
OP
|
$65.75
|
|
|
Service Code
|
NDC 48433021501
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna American Axle |
$42.74
|
| Rate for Payer: Aetna Commercial |
$55.89
|
| Rate for Payer: Aetna Medicare |
$32.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.74
|
| Rate for Payer: BCBS Complete |
$26.30
|
| Rate for Payer: Cash Price |
$52.60
|
| Rate for Payer: Cofinity Advantage |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$56.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.60
|
| Rate for Payer: Healthscope Commercial |
$59.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.31
|
| Rate for Payer: PHP Commercial |
$55.89
|
| Rate for Payer: Priority Health SBD |
$41.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.74
|
| Rate for Payer: UHC Core |
$34.26
|
| Rate for Payer: UHC Exchange |
$25.84
|
| Rate for Payer: UMR Bronson Commercial |
$24.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.31
|
|
|
SODIUM CHLORIDE 4 MEQ/ML ORAL FOR FEEDS
|
Facility
|
OP
|
$54.87
|
|
|
Service Code
|
NDC 00536137785
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$49.38 |
| Rate for Payer: Aetna American Axle |
$35.67
|
| Rate for Payer: Aetna Commercial |
$46.64
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.67
|
| Rate for Payer: BCBS Complete |
$21.95
|
| Rate for Payer: Cash Price |
$43.90
|
| Rate for Payer: Cofinity Advantage |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$47.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.90
|
| Rate for Payer: Healthscope Commercial |
$49.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.64
|
| Rate for Payer: Priority Health SBD |
$34.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.67
|
| Rate for Payer: UHC Core |
$28.59
|
| Rate for Payer: UHC Exchange |
$21.56
|
| Rate for Payer: UMR Bronson Commercial |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
NDC 50190014123
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna American Axle |
$1.84
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.84
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
