|
WARFARIN 5 MG TABLET
|
Facility
|
OP
|
$3.09
|
|
|
Service Code
|
NDC 62584099411
|
| Hospital Charge Code |
8751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna American Axle |
$2.01
|
| Rate for Payer: Aetna Commercial |
$2.63
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.01
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cofinity Advantage |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.47
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.63
|
| Rate for Payer: Priority Health SBD |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.01
|
| Rate for Payer: UHC Core |
$1.61
|
| Rate for Payer: UHC Exchange |
$1.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.32
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 409397701
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 72572074701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Advantage |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.59
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Exchange |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
NDC 00517301001
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna American Axle |
$13.95
|
| Rate for Payer: Aetna Commercial |
$18.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cofinity Advantage |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.09
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 00409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
NDC 63323018520
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 63323018507
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.42
|
| Rate for Payer: UHC Core |
$10.76
|
| Rate for Payer: UHC Exchange |
$8.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 72572074710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Advantage |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.59
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.78
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Exchange |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna American Axle |
$9.75
|
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Advantage |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.75
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Exchange |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 00409488724
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Advantage |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.46
|
|
|
Service Code
|
NDC 00517301025
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna American Axle |
$13.95
|
| Rate for Payer: Aetna Commercial |
$18.24
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cofinity Advantage |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.09
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$11.18
|
| Rate for Payer: UHC Exchange |
$8.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
NDC 63323018520
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.53
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Exchange |
$10.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna American Axle |
$12.44
|
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.36
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$29.37
|
|
|
Service Code
|
NDC 00409488799
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna American Axle |
$19.09
|
| Rate for Payer: Aetna Commercial |
$24.96
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.09
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Advantage |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.03
|
| Rate for Payer: PHP Commercial |
$24.96
|
| Rate for Payer: Priority Health SBD |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Exchange |
$11.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.03
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 00409488724
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
NDC 72572074701
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Advantage |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.59
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
