|
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 Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.50
|
| 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: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| 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
|
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 Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| 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: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| 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
|
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 Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| 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: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| 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
|
$305.00
|
|
|
Service Code
|
NDC 00409114102
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna American Axle |
$198.25
|
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.75
|
|
|
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 |
$132.98 |
| 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 Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| 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: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| 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
|
$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 Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| 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: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| 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
|
$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: Cash Price |
$252.00
|
| 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: Cofinity Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.50
|
| 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: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| 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
|
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 Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| 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: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| 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
|
$275.00
|
|
|
Service Code
|
NDC 63323008861
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
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 Commercial |
$518.00
|
| Rate for Payer: Cofinity Commercial |
$636.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$518.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$629.00
|
| Rate for Payer: PHP Commercial |
$629.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.00
|
| Rate for Payer: Priority Health SBD |
$466.20
|
| 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
|
OP
|
$275.00
|
|
|
Service Code
|
NDC 63323008861
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$137.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
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 |
$132.98 |
| 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 Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| 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: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| 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
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$132.98 |
| 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 Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| 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: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| 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 Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.50
|
| 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: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health SBD |
$198.45
|
| 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
|
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 Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$270.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.50
|
| 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: PHP Commercial |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| 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 (TPN COMPONENT)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
NDC 09900001915
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna American Axle |
$198.25
|
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.75
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
NDC 09900001915
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.85 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna American Axle |
$198.25
|
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: UMR Bronson Commercial |
$112.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.75
|
|
|
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 Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.18
|
| 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: PHP Commercial |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health SBD |
$1.06
|
| 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
|
$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 Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.18
|
| 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: PHP Commercial |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| 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
|
$65.75
|
|
|
Service Code
|
NDC 48433021501
|
| Hospital Charge Code |
150948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$59.18 |
| 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 Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$56.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.60
|
| Rate for Payer: Healthscope Commercial |
$59.18
|
| 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: PHP Commercial |
$55.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.74
|
| Rate for Payer: Priority Health SBD |
$41.42
|
| 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 |
$27.44
|
| 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 Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$47.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.41
|
| 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: PHP Commercial |
$46.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.67
|
| Rate for Payer: Priority Health SBD |
$34.57
|
| Rate for Payer: UMR Bronson Commercial |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
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 Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$47.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.41
|
| 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: PHP Commercial |
$46.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.67
|
| 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 |
$59.18 |
| 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 Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$56.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.60
|
| Rate for Payer: Healthscope Commercial |
$59.18
|
| 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: PHP Commercial |
$55.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.74
|
| 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 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 83490020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna American Axle |
$2.14
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health SBD |
$2.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 83490020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna American Axle |
$2.14
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health SBD |
$2.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
