|
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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| 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 |
$33.60
|
| 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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| 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
|
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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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
|
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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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 |
$33.60
|
| 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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.45 % IV ADDITIONAL SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00264780200
|
| Hospital Charge Code |
200165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| 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 Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| 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 |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| 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
|
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 |
$33.60
|
| 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 Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| 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: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.21
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna American Axle |
$4.04
|
| Rate for Payer: Aetna Commercial |
$5.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.04
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Cofinity Commercial |
$5.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.97
|
| Rate for Payer: Healthscope Commercial |
$5.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.28
|
| Rate for Payer: PHP Commercial |
$5.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.04
|
| Rate for Payer: Priority Health SBD |
$3.91
|
| Rate for Payer: UMR Bronson Commercial |
$2.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.66
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.87
|
|
|
Service Code
|
NDC 00536250676
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna American Axle |
$4.47
|
| Rate for Payer: Aetna Commercial |
$5.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.47
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$4.81
|
| Rate for Payer: Cofinity Commercial |
$5.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$6.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.84
|
| Rate for Payer: PHP Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.47
|
| Rate for Payer: Priority Health SBD |
$4.33
|
| Rate for Payer: UMR Bronson Commercial |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.15
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.21
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna American Axle |
$4.04
|
| Rate for Payer: Aetna Commercial |
$5.28
|
| Rate for Payer: Aetna Medicare |
$3.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.04
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Cofinity Commercial |
$5.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.97
|
| Rate for Payer: Healthscope Commercial |
$5.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.28
|
| Rate for Payer: PHP Commercial |
$5.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.04
|
| Rate for Payer: Priority Health SBD |
$3.91
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.66
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.87
|
|
|
Service Code
|
NDC 00536250676
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Aetna American Axle |
$4.47
|
| Rate for Payer: Aetna Commercial |
$5.84
|
| Rate for Payer: Aetna Medicare |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.47
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$4.81
|
| Rate for Payer: Cofinity Commercial |
$5.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$6.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.84
|
| Rate for Payer: PHP Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.47
|
| Rate for Payer: Priority Health SBD |
$4.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.15
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: Aetna Medicare |
$2.64
|
| Rate for Payer: Aetna American Axle |
$3.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.43
|
| Rate for Payer: BCBS Complete |
$2.11
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: Priority Health SBD |
$3.33
|
| Rate for Payer: UMR Bronson Commercial |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna American Axle |
$3.43
|
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.43
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: Priority Health SBD |
$3.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
SODIUM CHLORIDE 0.9 % BOLUS FOR AMNIOINFUSION (OB)
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
158682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$6.91 |
| Rate for Payer: BCBS Trust/PPO |
$6.91
|
| Rate for Payer: BCN Commercial |
$6.91
|
|
|
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 Commercial |
$29.02
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.02
|
| 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 |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| 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 |
$31.10
|
|
|
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 |
$3.44 |
| 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 |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Commercial |
$29.02
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.02
|
| 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 |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health SBD |
$26.12
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
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 Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| 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: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| 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 % FLUSH SOLUTION 100 ML BAG
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| 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 |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| 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: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| 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 |
$6.91 |
| 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 |
$6.91
|
| Rate for Payer: BCN Commercial |
$6.91
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| 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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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
|
$3.14
|
|
|
Service Code
|
NDC 00378698601
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna American Axle |
$2.04
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
