|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$32.04
|
|
|
Service Code
|
NDC 09900000426
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Aetna American Axle |
$20.83
|
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: Aetna Medicare |
$16.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.83
|
| Rate for Payer: BCBS Complete |
$12.82
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cofinity Advantage |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.03
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health SBD |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.83
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: UHC Exchange |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.03
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| 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: 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: UMR Bronson Commercial |
$31.92
|
| 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
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$85.67
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Advantage |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.69
|
| Rate for Payer: UHC Core |
$44.63
|
| Rate for Payer: UHC Exchange |
$33.67
|
| Rate for Payer: UMR Bronson Commercial |
$31.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$85.67
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.69 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Advantage |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: UMR Bronson Commercial |
$37.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
NDC 00409490264
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| 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: 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: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.41
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$47.62
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity 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: MI Amish Medical Board Commercial |
$38.10
|
| 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: UHC All Payor (Choice/PPO) |
$30.95
|
| Rate for Payer: UHC Core |
$24.81
|
| Rate for Payer: UHC Exchange |
$18.71
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
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) IV SYRINGE (CODE)
|
Facility
|
IP
|
$110.52
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.63 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna American Axle |
$71.84
|
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.84
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Advantage |
$77.36
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.89
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: Priority Health SBD |
$69.63
|
| Rate for Payer: UMR Bronson Commercial |
$48.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$110.52
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna American Axle |
$71.84
|
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Aetna Medicare |
$55.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.84
|
| Rate for Payer: BCBS Complete |
$44.21
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Advantage |
$77.36
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.89
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: Priority Health SBD |
$69.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.84
|
| Rate for Payer: UHC Core |
$57.58
|
| Rate for Payer: UHC Exchange |
$43.43
|
| Rate for Payer: UMR Bronson Commercial |
$40.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$130.52
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.29 |
| Max. Negotiated Rate |
$117.47 |
| Rate for Payer: Aetna American Axle |
$84.84
|
| Rate for Payer: Aetna Commercial |
$110.94
|
| Rate for Payer: Aetna Medicare |
$65.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.84
|
| Rate for Payer: BCBS Complete |
$52.21
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Advantage |
$91.36
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$117.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.89
|
| Rate for Payer: PHP Commercial |
$110.94
|
| Rate for Payer: Priority Health SBD |
$82.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.84
|
| Rate for Payer: UHC Core |
$68.00
|
| Rate for Payer: UHC Exchange |
$51.29
|
| Rate for Payer: UMR Bronson Commercial |
$48.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.89
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$130.52
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$117.47 |
| Rate for Payer: Aetna American Axle |
$84.84
|
| Rate for Payer: Aetna Commercial |
$110.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.84
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Advantage |
$91.36
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$117.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.89
|
| Rate for Payer: PHP Commercial |
$110.94
|
| Rate for Payer: Priority Health SBD |
$82.23
|
| Rate for Payer: UMR Bronson Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.89
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$103.68
|
|
|
Service Code
|
NDC 00990792403
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.36 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: Aetna American Axle |
$67.39
|
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: Aetna Medicare |
$51.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.39
|
| Rate for Payer: BCBS Complete |
$41.47
|
| Rate for Payer: Cash Price |
$82.94
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.94
|
| Rate for Payer: Healthscope Commercial |
$93.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.76
|
| Rate for Payer: PHP Commercial |
$88.13
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.39
|
| Rate for Payer: UHC Core |
$54.02
|
| Rate for Payer: UHC Exchange |
$40.75
|
| Rate for Payer: UMR Bronson Commercial |
$38.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.76
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338007704
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338007704
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
NDC 00990792409
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Medicare |
$55.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Advantage |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.74
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.57
|
| Rate for Payer: UHC Core |
$58.17
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UMR Bronson Commercial |
$41.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
NDC 00990792409
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna American Axle |
$72.57
|
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Advantage |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.74
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: UMR Bronson Commercial |
$49.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
|
DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$103.68
|
|
|
Service Code
|
NDC 00990792403
|
| Hospital Charge Code |
9812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: Aetna American Axle |
$67.39
|
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.39
|
| Rate for Payer: Cash Price |
$82.94
|
| Rate for Payer: Cofinity Advantage |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$89.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.94
|
| Rate for Payer: Healthscope Commercial |
$93.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.76
|
| Rate for Payer: PHP Commercial |
$88.13
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: UMR Bronson Commercial |
$45.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.76
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
300209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
300209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00264761210
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
NDC 00990792609
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Advantage |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: UMR Bronson Commercial |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 338008504
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79.75
|
|
|
Service Code
|
NDC 00990792609
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: BCBS Complete |
$31.90
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Advantage |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.84
|
| Rate for Payer: UHC Core |
$41.55
|
| Rate for Payer: UHC Exchange |
$31.34
|
| Rate for Payer: UMR Bronson Commercial |
$29.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 00338008503
|
| Hospital Charge Code |
9814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.67
|
| Rate for Payer: UHC Core |
$35.01
|
| Rate for Payer: UHC Exchange |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
