|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$74.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLN FOR WOUND VAC THERAPY ONLY
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
180209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLN FOR WOUND VAC THERAPY ONLY
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
180209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$165.19
|
|
|
Service Code
|
NDC 39328006712
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Aetna American Axle |
$107.37
|
| Rate for Payer: Aetna Commercial |
$140.41
|
| Rate for Payer: Aetna Medicare |
$82.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: BCBS Complete |
$66.08
|
| Rate for Payer: Cash Price |
$132.15
|
| Rate for Payer: Cofinity Commercial |
$115.63
|
| Rate for Payer: Cofinity Commercial |
$142.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.15
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.41
|
| Rate for Payer: PHP Commercial |
$140.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.37
|
| Rate for Payer: Priority Health SBD |
$104.07
|
| Rate for Payer: UMR Bronson Commercial |
$61.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.89
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$62.91
|
|
|
Service Code
|
NDC 00436067216
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 09900001864
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 00436067216
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$165.19
|
|
|
Service Code
|
NDC 39328006712
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Aetna American Axle |
$107.37
|
| Rate for Payer: Aetna Commercial |
$140.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: Cash Price |
$132.15
|
| Rate for Payer: Cofinity Commercial |
$115.63
|
| Rate for Payer: Cofinity Commercial |
$142.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.15
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.41
|
| Rate for Payer: PHP Commercial |
$140.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.37
|
| Rate for Payer: Priority Health SBD |
$104.07
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.89
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 09900001864
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
OP
|
$62.91
|
|
|
Service Code
|
NDC 00436093616
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 00436093616
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
OP
|
$62.91
|
|
|
Service Code
|
NDC 00436094616
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 09900001866
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 00436094616
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.89
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 09900001866
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM METABISULFITE (BULK) 100 % GRANULES
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 51552006909
|
| Hospital Charge Code |
23041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna American Axle |
$15.92
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.92
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
SODIUM METABISULFITE (BULK) 100 % GRANULES
|
Facility
|
OP
|
$24.50
|
|
|
Service Code
|
NDC 51552006909
|
| Hospital Charge Code |
23041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna American Axle |
$15.92
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.92
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
OP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna American Axle |
$454.53
|
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Cofinity Commercial |
$489.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$6.51
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$4.99
|
| Rate for Payer: Priority Health SBD |
$440.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$4.15
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: UMR Bronson Commercial |
$258.73
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
IP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.68 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna American Axle |
$454.53
|
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.53
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$489.50
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.53
|
| Rate for Payer: Priority Health SBD |
$440.55
|
| Rate for Payer: UMR Bronson Commercial |
$307.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.47 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna American Axle |
$279.90
|
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.90
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$301.43
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.90
|
| Rate for Payer: Priority Health SBD |
$271.29
|
| Rate for Payer: UMR Bronson Commercial |
$189.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.62
|
|
|
Service Code
|
NDC 71288020202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
