|
DEXTROSE 5% IN WATER INTRAVENOUS SOLUTION (DOSE, ADMIN OVER & INDICATION REQUIRED)
|
Facility
|
OP
|
$71.78
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
301087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$30.23
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$24.19
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health SBD |
$45.22
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$62.71
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$56.44 |
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| 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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| 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 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| 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 Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| 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: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna American Axle |
$39.31
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$30.23
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS Complete |
$24.19
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$50.17
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$56.44
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$51.40
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$22.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.35
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
NDC 00338978901
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
NDC 00338978904
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$108.48
|
|
|
Service Code
|
NDC 00264738750
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna American Axle |
$70.51
|
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna Medicare |
$54.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.51
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$40.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
NDC 00338978901
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 00338071906
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna American Axle |
$71.60
|
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$48.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.62
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
NDC 00338978904
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$108.48
|
|
|
Service Code
|
NDC 00264738750
|
| Hospital Charge Code |
2367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.73 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna American Axle |
$70.51
|
| Rate for Payer: Aetna Commercial |
$92.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.51
|
| Rate for Payer: Cash Price |
$86.78
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$93.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$97.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.21
|
| Rate for Payer: PHP Commercial |
$92.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.51
|
| Rate for Payer: Priority Health SBD |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.36
|
|
|
DEXTROSE-GRAM-SOD CITRATE-GRAM-CITRIC AC FLUSH SOLUTION
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 09900000932
|
| Hospital Charge Code |
300358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna American Axle |
$0.46
|
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.46
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Cofinity Commercial |
$0.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health SBD |
$0.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
DEXTROSE-GRAM-SOD CITRATE-GRAM-CITRIC AC FLUSH SOLUTION
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 09900000932
|
| Hospital Charge Code |
300358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna American Axle |
$0.46
|
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.46
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Cofinity Commercial |
$0.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health SBD |
$0.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-401 (K-4/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000034
|
| Hospital Charge Code |
150776
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000035
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-402 (K-0/CA-3) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000035
|
| Hospital Charge Code |
150777
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-453 (K-2/CA-0) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 99000000036
|
| Hospital Charge Code |
150773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-453 (K-2/CA-0) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 99000000036
|
| Hospital Charge Code |
150773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-456 (K-4/CA-0) SOLUTION
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
NDC 09900000849
|
| Hospital Charge Code |
180369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.87 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$91.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIALYSATE RFP-456 (K-4/CA-0) SOLUTION
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
NDC 09900000849
|
| Hospital Charge Code |
180369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna American Axle |
$135.72
|
| Rate for Payer: Aetna Commercial |
$177.48
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.72
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$187.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.48
|
| Rate for Payer: PHP Commercial |
$177.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.72
|
| Rate for Payer: Priority Health SBD |
$131.54
|
| Rate for Payer: UMR Bronson Commercial |
$77.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.60
|
|
|
DIATRIZOATE MEGLUMINE 18 % URETHRAL SOLUTION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
9823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
