|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44377
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONVERSION OF PERCUTANEOUS GASTROSTOMY TUBE TO PERCUTANEOUS JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44373
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 44372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
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 Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.79
|
| 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: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.16
|
| Rate for Payer: Priority Health SBD |
$7.91
|
| 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 Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.79
|
| 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: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.16
|
| 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
|
$40.14
|
|
|
Service Code
|
NDC 00409577901
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$36.13 |
| Rate for Payer: Aetna American Axle |
$26.09
|
| Rate for Payer: Aetna Commercial |
$34.12
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.09
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Cofinity Commercial |
$28.10
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$36.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.12
|
| Rate for Payer: PHP Commercial |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.09
|
| Rate for Payer: Priority Health SBD |
$25.29
|
| Rate for Payer: UMR Bronson Commercial |
$14.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.11
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
IP
|
$40.14
|
|
|
Service Code
|
NDC 00409577901
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$36.13 |
| Rate for Payer: Aetna American Axle |
$26.09
|
| Rate for Payer: Aetna Commercial |
$34.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.09
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Cofinity Commercial |
$28.10
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$36.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.12
|
| Rate for Payer: PHP Commercial |
$34.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.09
|
| Rate for Payer: Priority Health SBD |
$25.29
|
| Rate for Payer: UMR Bronson Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.11
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$68.53
|
|
|
Service Code
|
NDC 69784023120
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: BCBS Complete |
$27.41
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| 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: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$25.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
|
|
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 Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| 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: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| 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
|
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 Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.38
|
| 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: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| 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
|
$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 Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| 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: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| 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
|
$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 Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| 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: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| 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
|
$54.07
|
|
|
Service Code
|
NDC 69784023010
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$48.66 |
| Rate for Payer: Aetna American Axle |
$35.15
|
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna Medicare |
$27.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.15
|
| Rate for Payer: BCBS Complete |
$21.63
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cofinity Commercial |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$46.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.96
|
| Rate for Payer: PHP Commercial |
$45.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.15
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$20.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50.29
|
|
|
Service Code
|
NDC 69784023020
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$45.26 |
| Rate for Payer: Aetna American Axle |
$32.69
|
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.69
|
| Rate for Payer: BCBS Complete |
$20.12
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$43.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.23
|
| Rate for Payer: Healthscope Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.75
|
| Rate for Payer: PHP Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.69
|
| Rate for Payer: Priority Health SBD |
$31.68
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
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 Commercial |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.61
|
| 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: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| 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
|
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 Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| 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: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| 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 Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.38
|
| 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: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| 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
|
$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 Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| 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: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| 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
|
$50.29
|
|
|
Service Code
|
NDC 69784023020
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$45.26 |
| Rate for Payer: Aetna American Axle |
$32.69
|
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.69
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$43.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.23
|
| Rate for Payer: Healthscope Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.75
|
| Rate for Payer: PHP Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.69
|
| Rate for Payer: Priority Health SBD |
$31.68
|
| Rate for Payer: UMR Bronson Commercial |
$22.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
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 Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| 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: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| 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
|
$36.41
|
|
|
Service Code
|
NDC 69784022910
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
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 Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| 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: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| 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
|
|
