|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$554.88
|
|
|
Service Code
|
NDC 60687043192
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$499.39 |
| Rate for Payer: Aetna Commercial |
$471.65
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.40
|
| Rate for Payer: BCBS Complete |
$221.95
|
| Rate for Payer: BCBS MAPPO |
$138.72
|
| Rate for Payer: BCBS Trust/PPO |
$456.17
|
| Rate for Payer: BCN Commercial |
$431.42
|
| Rate for Payer: BCN Medicare Advantage |
$138.72
|
| Rate for Payer: Cash Price |
$443.90
|
| Rate for Payer: Cofinity Commercial |
$477.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$499.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.65
|
| Rate for Payer: Nomi Health Commercial |
$455.00
|
| Rate for Payer: PACE Senior Care Partners |
$131.78
|
| Rate for Payer: PACE SWMI |
$138.72
|
| Rate for Payer: PHP Commercial |
$471.65
|
| Rate for Payer: PHP Medicare Advantage |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.67
|
| Rate for Payer: Priority Health HMO/PPO |
$482.75
|
| Rate for Payer: Priority Health Medicare |
$140.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.77
|
| Rate for Payer: Railroad Medicare Medicare |
$138.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.29
|
| Rate for Payer: UHC Core |
$463.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.72
|
| Rate for Payer: UHC Exchange |
$138.72
|
| Rate for Payer: UHC Medicare Advantage |
$138.72
|
| Rate for Payer: VA VA |
$138.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.16
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$5.76
|
|
|
Service Code
|
NDC 60687043199
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.90
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PHP Commercial |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.07
|
| Rate for Payer: UHC Core |
$4.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.32
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.71
|
|
|
Service Code
|
NDC 00904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$1.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.52
|
| Rate for Payer: BCN Commercial |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$1.68
|
| Rate for Payer: Cash Price |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$5.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.70
|
| Rate for Payer: Nomi Health Commercial |
$5.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.59
|
| Rate for Payer: PACE SWMI |
$1.68
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.36
|
| Rate for Payer: Priority Health HMO/PPO |
$5.84
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.90
|
| Rate for Payer: UHC Core |
$5.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.68
|
| Rate for Payer: UHC Exchange |
$1.68
|
| Rate for Payer: UHC Medicare Advantage |
$1.68
|
| Rate for Payer: VA VA |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.03
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$45.44
|
|
|
Service Code
|
NDC 63323036711
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$38.62
|
| Rate for Payer: Aetna Medicare |
$11.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.20
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$11.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.36
|
| Rate for Payer: BCN Commercial |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$11.36
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.62
|
| Rate for Payer: Nomi Health Commercial |
$37.26
|
| Rate for Payer: PACE Senior Care Partners |
$10.79
|
| Rate for Payer: PACE SWMI |
$11.36
|
| Rate for Payer: PHP Commercial |
$38.62
|
| Rate for Payer: PHP Medicare Advantage |
$11.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.54
|
| Rate for Payer: Priority Health HMO/PPO |
$39.53
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.44
|
| Rate for Payer: Railroad Medicare Medicare |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.99
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.36
|
| Rate for Payer: UHC Exchange |
$11.36
|
| Rate for Payer: UHC Medicare Advantage |
$11.36
|
| Rate for Payer: VA VA |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.08
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$45.44
|
|
|
Service Code
|
NDC 63323036711
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCN Commercial |
$35.12
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.35
|
| Rate for Payer: Healthscope Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.62
|
| Rate for Payer: Nomi Health Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.54
|
| Rate for Payer: Priority Health HMO/PPO |
$39.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.99
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.08
|
|
|
POTASSIUM ACETATE 20 MEQ/100 ML (IVPB PREMIX)
|
Facility
|
IP
|
$59.44
|
|
|
Service Code
|
NDC 09900001094
|
| Hospital Charge Code |
300104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.52
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: Cash Price |
$47.55
|
| Rate for Payer: Cofinity Commercial |
$51.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.55
|
| Rate for Payer: Healthscope Commercial |
$53.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: Nomi Health Commercial |
$48.74
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.64
|
| Rate for Payer: Priority Health HMO/PPO |
$51.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.31
|
| Rate for Payer: UHC Core |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.58
|
|
|
POTASSIUM ACETATE 20 MEQ/100 ML (IVPB PREMIX)
|
Facility
|
OP
|
$59.44
|
|
|
Service Code
|
NDC 09900001094
|
| Hospital Charge Code |
300104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: Aetna Medicare |
$15.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.58
|
| Rate for Payer: BCBS Complete |
$23.78
|
| Rate for Payer: BCBS MAPPO |
$14.86
|
| Rate for Payer: BCBS Trust/PPO |
$48.87
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: BCN Medicare Advantage |
$14.86
|
| Rate for Payer: Cash Price |
$47.55
|
| Rate for Payer: Cofinity Commercial |
$51.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$53.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: Nomi Health Commercial |
$48.74
|
| Rate for Payer: PACE Senior Care Partners |
$14.12
|
| Rate for Payer: PACE SWMI |
$14.86
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.64
|
| Rate for Payer: Priority Health HMO/PPO |
$51.71
|
| Rate for Payer: Priority Health Medicare |
$15.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.31
|
| Rate for Payer: UHC Core |
$49.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.86
|
| Rate for Payer: UHC Exchange |
$14.86
|
| Rate for Payer: UHC Medicare Advantage |
$14.86
|
| Rate for Payer: VA VA |
$14.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.58
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: BCBS Trust/PPO |
$33.06
|
| Rate for Payer: BCN Commercial |
$31.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Nomi Health Commercial |
$33.21
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health HMO/PPO |
$35.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.66
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS MAPPO |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$33.30
|
| Rate for Payer: BCN Commercial |
$31.49
|
| Rate for Payer: BCN Medicare Advantage |
$10.12
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Nomi Health Commercial |
$33.21
|
| Rate for Payer: PACE Senior Care Partners |
$9.62
|
| Rate for Payer: PACE SWMI |
$10.12
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Medicare Advantage |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health HMO/PPO |
$35.24
|
| Rate for Payer: Priority Health Medicare |
$10.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.12
|
| Rate for Payer: UHC Exchange |
$10.12
|
| Rate for Payer: UHC Medicare Advantage |
$10.12
|
| Rate for Payer: VA VA |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.80
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.89
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: PACE Senior Care Partners |
$5.17
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health HMO/PPO |
$18.93
|
| Rate for Payer: Priority Health Medicare |
$5.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.15
|
| Rate for Payer: UHC Core |
$18.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.44
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UHC Medicare Advantage |
$5.44
|
| Rate for Payer: VA VA |
$5.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$16.82
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health HMO/PPO |
$18.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.15
|
| Rate for Payer: UHC Core |
$18.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$151.27
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.33 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: BCBS Trust/PPO |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$123.48
|
| Rate for Payer: BCBS Trust/PPO |
$65.64
|
| Rate for Payer: BCN Commercial |
$57.94
|
| Rate for Payer: BCN Commercial |
$116.90
|
| Rate for Payer: BCN Commercial |
$62.14
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Nomi Health Commercial |
$124.04
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health HMO/PPO |
$69.96
|
| Rate for Payer: Priority Health HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health HMO/PPO |
$131.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.12
|
| Rate for Payer: UHC Core |
$126.31
|
| Rate for Payer: UHC Core |
$67.14
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$151.27
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$20.91
|
| Rate for Payer: Aetna Medicare |
$39.33
|
| Rate for Payer: Aetna Medicare |
$19.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.13
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Complete |
$60.51
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS MAPPO |
$20.10
|
| Rate for Payer: BCBS MAPPO |
$37.82
|
| Rate for Payer: BCBS MAPPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCBS Trust/PPO |
$124.36
|
| Rate for Payer: BCBS Trust/PPO |
$66.11
|
| Rate for Payer: BCN Commercial |
$58.29
|
| Rate for Payer: BCN Commercial |
$62.52
|
| Rate for Payer: BCN Commercial |
$117.61
|
| Rate for Payer: BCN Medicare Advantage |
$37.82
|
| Rate for Payer: BCN Medicare Advantage |
$18.74
|
| Rate for Payer: BCN Medicare Advantage |
$20.10
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.82
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.58
|
| Rate for Payer: Nomi Health Commercial |
$65.94
|
| Rate for Payer: Nomi Health Commercial |
$124.04
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: PACE Senior Care Partners |
$19.10
|
| Rate for Payer: PACE Senior Care Partners |
$35.93
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.74
|
| Rate for Payer: PACE SWMI |
$37.82
|
| Rate for Payer: PACE SWMI |
$20.10
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Medicare Advantage |
$18.74
|
| Rate for Payer: PHP Medicare Advantage |
$20.10
|
| Rate for Payer: PHP Medicare Advantage |
$37.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health HMO/PPO |
$69.96
|
| Rate for Payer: Priority Health HMO/PPO |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Medicare |
$38.20
|
| Rate for Payer: Priority Health Medicare |
$20.30
|
| Rate for Payer: Priority Health Medicare |
$18.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.35
|
| Rate for Payer: Railroad Medicare Medicare |
$18.74
|
| Rate for Payer: Railroad Medicare Medicare |
$20.10
|
| Rate for Payer: Railroad Medicare Medicare |
$37.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.12
|
| Rate for Payer: UHC Core |
$67.14
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: UHC Core |
$126.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.74
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Exchange |
$37.82
|
| Rate for Payer: UHC Exchange |
$20.10
|
| Rate for Payer: UHC Medicare Advantage |
$37.82
|
| Rate for Payer: UHC Medicare Advantage |
$18.74
|
| Rate for Payer: UHC Medicare Advantage |
$20.10
|
| Rate for Payer: VA VA |
$18.74
|
| Rate for Payer: VA VA |
$20.10
|
| Rate for Payer: VA VA |
$37.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 00121168050
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.16
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
NDC 50268067415
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cofinity Commercial |
$8.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.86
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.36
|
| Rate for Payer: Nomi Health Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.39
|
| Rate for Payer: Priority Health HMO/PPO |
$8.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.37
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$28.70
|
|
|
Service Code
|
NDC 60687062858
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$23.43
|
| Rate for Payer: BCN Commercial |
$22.18
|
| Rate for Payer: Cash Price |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$25.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.53
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.66
|
| Rate for Payer: Priority Health HMO/PPO |
$24.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.52
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
NDC 50268067411
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cofinity Commercial |
$8.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.86
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.36
|
| Rate for Payer: Nomi Health Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.39
|
| Rate for Payer: Priority Health HMO/PPO |
$8.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.37
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.43
|
|
|
Service Code
|
NDC 60687062844
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.68
|
| Rate for Payer: Priority Health HMO/PPO |
$14.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
NDC 00904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna Commercial |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$18.66
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: PHP Commercial |
$20.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.70
|
| Rate for Payer: Priority Health HMO/PPO |
$21.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Core |
$20.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$28.98
|
|
|
Service Code
|
NDC 60687034107
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$23.66
|
| Rate for Payer: BCN Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.84
|
| Rate for Payer: Priority Health HMO/PPO |
$25.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.50
|
| Rate for Payer: UHC Core |
$24.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.74
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$28.98
|
|
|
Service Code
|
NDC 60687034107
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.06
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS MAPPO |
$7.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.82
|
| Rate for Payer: BCN Commercial |
$22.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.24
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.24
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: PACE Senior Care Partners |
$6.88
|
| Rate for Payer: PACE SWMI |
$7.24
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Medicare Advantage |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.84
|
| Rate for Payer: Priority Health HMO/PPO |
$25.21
|
| Rate for Payer: Priority Health Medicare |
$7.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.50
|
| Rate for Payer: UHC Core |
$24.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.24
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.24
|
| Rate for Payer: VA VA |
$7.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.74
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 66689004750
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
NDC 50268067415
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.07
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Commercial |
$7.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.46
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cofinity Commercial |
$8.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.36
|
| Rate for Payer: Nomi Health Commercial |
$8.06
|
| Rate for Payer: PACE Senior Care Partners |
$2.33
|
| Rate for Payer: PACE SWMI |
$2.46
|
| Rate for Payer: PHP Commercial |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.39
|
| Rate for Payer: Priority Health HMO/PPO |
$8.55
|
| Rate for Payer: Priority Health Medicare |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.46
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
| Rate for Payer: VA VA |
$2.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.37
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 00121168050
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.43
|
|
|
Service Code
|
NDC 60687062844
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.13
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS MAPPO |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: BCN Medicare Advantage |
$4.11
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.11
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Nomi Health Commercial |
$13.47
|
| Rate for Payer: PACE Senior Care Partners |
$3.90
|
| Rate for Payer: PACE SWMI |
$4.11
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: PHP Medicare Advantage |
$4.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.68
|
| Rate for Payer: Priority Health HMO/PPO |
$14.29
|
| Rate for Payer: Priority Health Medicare |
$4.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.11
|
| Rate for Payer: UHC Exchange |
$4.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.11
|
| Rate for Payer: VA VA |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
|
