|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
NDC 00409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
NDC 00409488750
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$14.79
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488725
|
| 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 Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| 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: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| 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
|
$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 Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.02
|
| 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 |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409488799
|
| 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 Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| 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: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| 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
|
$13.75
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna American Axle |
$8.94
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$5.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| 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
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
NDC 63323018507
|
| 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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| 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
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
NDC 00409488724
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$13.75
|
|
|
Service Code
|
NDC 00409488717
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna American Axle |
$8.94
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 63323018507
|
| 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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| 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
|
OP
|
$23.68
|
|
|
Service Code
|
NDC 63323018520
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.79
|
|
|
Service Code
|
NDC 00409488723
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$23.68
|
|
|
Service Code
|
NDC 63323018508
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$21.46
|
|
|
Service Code
|
NDC 00517301001
|
| 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 Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.02
|
| 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 |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.10
|
|
|
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 Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.02
|
| 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 |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| 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 |
$16.10
|
|
|
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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| 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
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409488799
|
| 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 Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| 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: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| 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
|
$13.75
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna American Axle |
$8.94
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
NDC 00517301025
|
| 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 Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.02
|
| 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 |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| 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 |
$16.10
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$14.79
|
|
|
Service Code
|
NDC 00409488720
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna American Axle |
$9.61
|
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.83
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.61
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.09
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
|
OP
|
$13.75
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna American Axle |
$8.94
|
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$5.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.31
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 63323018507
|
| Hospital Charge Code |
301772
|
|
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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| 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 FOR SOLID FORM MIXTURES
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
301772
|
|
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 Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| 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: PHP Commercial |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
|
