|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 09900001911
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: Priority Health SBD |
$1.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.11
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 09900001911
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna American Axle |
$1.83
|
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: Priority Health SBD |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.11
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 00574007030
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Advantage |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.53
|
| Rate for Payer: UHC Core |
$8.44
|
| Rate for Payer: UHC Exchange |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$16.37
|
|
|
Service Code
|
NDC 00574006915
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna American Axle |
$10.64
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Advantage |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.28
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Advantage |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.53
|
| Rate for Payer: UHC Core |
$8.44
|
| Rate for Payer: UHC Exchange |
$6.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 00574006930
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Advantage |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 00574007030
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Advantage |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.15
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
OP
|
$37.80
|
|
|
Service Code
|
NDC 00574006945
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$34.02 |
| Rate for Payer: Aetna American Axle |
$24.57
|
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.57
|
| Rate for Payer: BCBS Complete |
$15.12
|
| Rate for Payer: Cash Price |
$30.24
|
| Rate for Payer: Cofinity Advantage |
$26.46
|
| Rate for Payer: Cofinity Commercial |
$32.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.24
|
| Rate for Payer: Healthscope Commercial |
$34.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.35
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: Priority Health SBD |
$23.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.57
|
| Rate for Payer: UHC Core |
$19.69
|
| Rate for Payer: UHC Exchange |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.35
|
|
|
DEXTROSE 40 % ORAL GEL
|
Facility
|
IP
|
$37.80
|
|
|
Service Code
|
NDC 00574006945
|
| Hospital Charge Code |
27466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$34.02 |
| Rate for Payer: Aetna American Axle |
$24.57
|
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.57
|
| Rate for Payer: Cash Price |
$30.24
|
| Rate for Payer: Cofinity Advantage |
$26.46
|
| Rate for Payer: Cofinity Commercial |
$32.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.24
|
| Rate for Payer: Healthscope Commercial |
$34.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.35
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: Priority Health SBD |
$23.81
|
| Rate for Payer: UMR Bronson Commercial |
$16.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.35
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UMR Bronson Commercial |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UMR Bronson Commercial |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 409664816
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 409664802
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 409664816
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.73
|
| Rate for Payer: UHC Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664816
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UMR Bronson Commercial |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
301983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$67.47 |
| Rate for Payer: Aetna American Axle |
$48.73
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: UMR Bronson Commercial |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$72.76
|
|
|
Service Code
|
NDC 76329330201
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Aetna American Axle |
$47.29
|
| Rate for Payer: Aetna Commercial |
$61.85
|
| Rate for Payer: Aetna Medicare |
$36.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.29
|
| Rate for Payer: BCBS Complete |
$29.10
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cofinity Advantage |
$50.93
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.21
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.57
|
| Rate for Payer: PHP Commercial |
$61.85
|
| Rate for Payer: Priority Health SBD |
$45.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.29
|
| Rate for Payer: UHC Core |
$37.91
|
| Rate for Payer: UHC Exchange |
$28.59
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.57
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$72.54
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Medicare |
$36.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: BCBS Complete |
$29.02
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Advantage |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.41
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$37.79
|
| Rate for Payer: UHC Exchange |
$28.51
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$72.54
|
|
|
Service Code
|
NDC 00409490264
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Medicare |
$36.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: BCBS Complete |
$29.02
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Advantage |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.41
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Core |
$37.79
|
| Rate for Payer: UHC Exchange |
$28.51
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$47.62
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Advantage |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| 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: Opus (Opus Packaging Group) HMA |
$35.72
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
