Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET

Facility

$6.77

Service Code	NDC 11523723401
Hospital Charge Code	25424
Hospital Revenue Code	637
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$5.75
Rate for Payer: BCBS Trust/PPO	$5.59
Rate for Payer: BCN Commercial	$5.59
Rate for Payer: Cash Price	$5.42
Rate for Payer: Cofinity Commercial	$5.82
Rate for Payer: Encore Health Key Benefits Commercial	$5.42
Rate for Payer: Healthscope Commercial	$6.09
Rate for Payer: Lakeland Regional Health Systems Commercial	$5.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.75
Rate for Payer: Nomi Health Commercial	$5.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.08
Rate for Payer: PHP Commercial	$5.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.89
Rate for Payer: Priority Health Narrow/Tiered Network	$4.71
Rate for Payer: UHC All Payor (Choice/PPO)	$5.96
Rate for Payer: UHC Core	$5.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$5.08

POSACONAZOLE 100 MG TABLET,DELAYED RELEASE

Facility

$1,548.45

Service Code	NDC 70748025807
Hospital Charge Code	169019
Hospital Revenue Code	637
Min. Negotiated Rate	$272.99
Max. Negotiated Rate	$1,393.61
Rate for Payer: Aetna Commercial	$1,316.18
Rate for Payer: Aetna Medicare	$402.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$483.89
Rate for Payer: Amish Plain Church Group Commercial	$483.89
Rate for Payer: BCBS Complete	$286.62
Rate for Payer: BCBS MAPPO	$387.11
Rate for Payer: BCBS Trust/PPO	$1,272.98
Rate for Payer: BCN Commercial	$1,272.98
Rate for Payer: BCN Medicare Advantage	$387.11
Rate for Payer: Cash Price	$1,238.76
Rate for Payer: Cofinity Commercial	$1,331.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$387.11
Rate for Payer: Healthscope Commercial	$1,393.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,161.34
Rate for Payer: Mclaren Medicaid	$272.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$406.47
Rate for Payer: Meridian Medicaid	$286.62
Rate for Payer: MI Amish Medical Board Commercial	$445.18
Rate for Payer: Molina Medicare/Medicaid	$425.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,316.18
Rate for Payer: Nomi Health Commercial	$1,269.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,161.34
Rate for Payer: PACE Senior Care Partners	$367.76
Rate for Payer: PACE SWMI	$387.11
Rate for Payer: PHP Commercial	$1,316.18
Rate for Payer: PHP Medicare Advantage	$387.11
Rate for Payer: Priority Health Choice Medicaid	$272.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,347.15
Rate for Payer: Priority Health Medicare	$390.98
Rate for Payer: Priority Health Narrow/Tiered Network	$1,077.72
Rate for Payer: Railroad Medicare Medicare	$387.11
Rate for Payer: UHC All Payor (Choice/PPO)	$1,362.64
Rate for Payer: UHC Core	$1,292.96
Rate for Payer: UHC Exchange	$387.11
Rate for Payer: UHC Medicaid	$272.99
Rate for Payer: UHC Medicare Advantage	$387.11
Rate for Payer: UHCCP Medicaid	$272.99
Rate for Payer: VA VA	$387.11
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,161.34

POSACONAZOLE 100 MG TABLET,DELAYED RELEASE

Facility

$1,548.45

Service Code	NDC 70748025807
Hospital Charge Code	169019
Hospital Revenue Code	637
Min. Negotiated Rate	$1,077.72
Max. Negotiated Rate	$1,393.61
Rate for Payer: Aetna Commercial	$1,316.18
Rate for Payer: BCBS Trust/PPO	$1,278.86
Rate for Payer: BCN Commercial	$1,278.86
Rate for Payer: Cash Price	$1,238.76
Rate for Payer: Cofinity Commercial	$1,331.67
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.76
Rate for Payer: Healthscope Commercial	$1,393.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,161.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,316.18
Rate for Payer: Nomi Health Commercial	$1,269.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,161.34
Rate for Payer: PHP Commercial	$1,316.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,347.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,077.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1,362.64
Rate for Payer: UHC Core	$1,292.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,161.34

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$7,552.64

Service Code	APR-DRG 7111
Min. Negotiated Rate	$7,192.99
Max. Negotiated Rate	$7,552.64
Rate for Payer: BCBS Complete	$7,552.64
Rate for Payer: Mclaren Medicaid	$7,192.99
Rate for Payer: Meridian Medicaid	$7,552.64
Rate for Payer: Priority Health Choice Medicaid	$7,192.99
Rate for Payer: UHC Medicaid	$7,192.99
Rate for Payer: UHCCP Medicaid	$7,192.99

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$23,373.06

Service Code	APR-DRG 7114
Min. Negotiated Rate	$22,260.06
Max. Negotiated Rate	$23,373.06
Rate for Payer: BCBS Complete	$23,373.06
Rate for Payer: Mclaren Medicaid	$22,260.06
Rate for Payer: Meridian Medicaid	$23,373.06
Rate for Payer: Priority Health Choice Medicaid	$22,260.06
Rate for Payer: UHC Medicaid	$22,260.06
Rate for Payer: UHCCP Medicaid	$22,260.06

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$9,710.16

Service Code	APR-DRG 7112
Min. Negotiated Rate	$9,247.77
Max. Negotiated Rate	$9,710.16
Rate for Payer: BCBS Complete	$9,710.16
Rate for Payer: Mclaren Medicaid	$9,247.77
Rate for Payer: Meridian Medicaid	$9,710.16
Rate for Payer: Priority Health Choice Medicaid	$9,247.77
Rate for Payer: UHC Medicaid	$9,247.77
Rate for Payer: UHCCP Medicaid	$9,247.77

POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE

Facility

$12,277.84

Service Code	APR-DRG 7113
Min. Negotiated Rate	$11,693.18
Max. Negotiated Rate	$12,277.84
Rate for Payer: BCBS Complete	$12,277.84
Rate for Payer: Mclaren Medicaid	$11,693.18
Rate for Payer: Meridian Medicaid	$12,277.84
Rate for Payer: Priority Health Choice Medicaid	$11,693.18
Rate for Payer: UHC Medicaid	$11,693.18
Rate for Payer: UHCCP Medicaid	$11,693.18

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$3,665.63

Service Code	APR-DRG 7211
Min. Negotiated Rate	$3,491.08
Max. Negotiated Rate	$3,665.63
Rate for Payer: BCBS Complete	$3,665.63
Rate for Payer: Mclaren Medicaid	$3,491.08
Rate for Payer: Meridian Medicaid	$3,665.63
Rate for Payer: Priority Health Choice Medicaid	$3,491.08
Rate for Payer: UHC Medicaid	$3,491.08
Rate for Payer: UHCCP Medicaid	$3,491.08

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$8,592.23

Service Code	APR-DRG 7213
Min. Negotiated Rate	$8,183.07
Max. Negotiated Rate	$8,592.23
Rate for Payer: BCBS Complete	$8,592.23
Rate for Payer: Mclaren Medicaid	$8,183.07
Rate for Payer: Meridian Medicaid	$8,592.23
Rate for Payer: Priority Health Choice Medicaid	$8,183.07
Rate for Payer: UHC Medicaid	$8,183.07
Rate for Payer: UHCCP Medicaid	$8,183.07

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$5,049.12

Service Code	APR-DRG 7212
Min. Negotiated Rate	$4,808.68
Max. Negotiated Rate	$5,049.12
Rate for Payer: BCBS Complete	$5,049.12
Rate for Payer: Mclaren Medicaid	$4,808.68
Rate for Payer: Meridian Medicaid	$5,049.12
Rate for Payer: Priority Health Choice Medicaid	$4,808.68
Rate for Payer: UHC Medicaid	$4,808.68
Rate for Payer: UHCCP Medicaid	$4,808.68

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$12,803.15

Service Code	APR-DRG 7214
Min. Negotiated Rate	$12,193.48
Max. Negotiated Rate	$12,803.15
Rate for Payer: BCBS Complete	$12,803.15
Rate for Payer: Mclaren Medicaid	$12,193.48
Rate for Payer: Meridian Medicaid	$12,803.15
Rate for Payer: Priority Health Choice Medicaid	$12,193.48
Rate for Payer: UHC Medicaid	$12,193.48
Rate for Payer: UHCCP Medicaid	$12,193.48

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$4,514.86

Service Code	APR-DRG 5613
Min. Negotiated Rate	$4,299.87
Max. Negotiated Rate	$4,514.86
Rate for Payer: BCBS Complete	$4,514.86
Rate for Payer: Mclaren Medicaid	$4,299.87
Rate for Payer: Meridian Medicaid	$4,514.86
Rate for Payer: Priority Health Choice Medicaid	$4,299.87
Rate for Payer: UHC Medicaid	$4,299.87
Rate for Payer: UHCCP Medicaid	$4,299.87

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$2,514.57

Service Code	APR-DRG 5612
Min. Negotiated Rate	$2,394.83
Max. Negotiated Rate	$2,514.57
Rate for Payer: BCBS Complete	$2,514.57
Rate for Payer: Mclaren Medicaid	$2,394.83
Rate for Payer: Meridian Medicaid	$2,514.57
Rate for Payer: Priority Health Choice Medicaid	$2,394.83
Rate for Payer: UHC Medicaid	$2,394.83
Rate for Payer: UHCCP Medicaid	$2,394.83

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$1,580.15

Service Code	APR-DRG 5611
Min. Negotiated Rate	$1,504.90
Max. Negotiated Rate	$1,580.15
Rate for Payer: BCBS Complete	$1,580.15
Rate for Payer: Mclaren Medicaid	$1,504.90
Rate for Payer: Meridian Medicaid	$1,580.15
Rate for Payer: Priority Health Choice Medicaid	$1,504.90
Rate for Payer: UHC Medicaid	$1,504.90
Rate for Payer: UHCCP Medicaid	$1,504.90

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE

Facility

$9,100.71

Service Code	APR-DRG 5614
Min. Negotiated Rate	$8,667.35
Max. Negotiated Rate	$9,100.71
Rate for Payer: BCBS Complete	$9,100.71
Rate for Payer: Mclaren Medicaid	$8,667.35
Rate for Payer: Meridian Medicaid	$9,100.71
Rate for Payer: Priority Health Choice Medicaid	$8,667.35
Rate for Payer: UHC Medicaid	$8,667.35
Rate for Payer: UHCCP Medicaid	$8,667.35

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$5,212.13

Service Code	APR-DRG 5482
Min. Negotiated Rate	$4,963.93
Max. Negotiated Rate	$5,212.13
Rate for Payer: BCBS Complete	$5,212.13
Rate for Payer: Mclaren Medicaid	$4,963.93
Rate for Payer: Meridian Medicaid	$5,212.13
Rate for Payer: Priority Health Choice Medicaid	$4,963.93
Rate for Payer: UHC Medicaid	$4,963.93
Rate for Payer: UHCCP Medicaid	$4,963.93

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$8,380.31

Service Code	APR-DRG 5483
Min. Negotiated Rate	$7,981.25
Max. Negotiated Rate	$8,380.31
Rate for Payer: BCBS Complete	$8,380.31
Rate for Payer: Mclaren Medicaid	$7,981.25
Rate for Payer: Meridian Medicaid	$8,380.31
Rate for Payer: Priority Health Choice Medicaid	$7,981.25
Rate for Payer: UHC Medicaid	$7,981.25
Rate for Payer: UHCCP Medicaid	$7,981.25

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$15,581.69

Service Code	APR-DRG 5484
Min. Negotiated Rate	$14,839.71
Max. Negotiated Rate	$15,581.69
Rate for Payer: BCBS Complete	$15,581.69
Rate for Payer: Mclaren Medicaid	$14,839.71
Rate for Payer: Meridian Medicaid	$15,581.69
Rate for Payer: Priority Health Choice Medicaid	$14,839.71
Rate for Payer: UHC Medicaid	$14,839.71
Rate for Payer: UHCCP Medicaid	$14,839.71

POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE

Facility

$2,102.31

Service Code	APR-DRG 5481
Min. Negotiated Rate	$2,002.20
Max. Negotiated Rate	$2,102.31
Rate for Payer: BCBS Complete	$2,102.31
Rate for Payer: Mclaren Medicaid	$2,002.20
Rate for Payer: Meridian Medicaid	$2,102.31
Rate for Payer: Priority Health Choice Medicaid	$2,002.20
Rate for Payer: UHC Medicaid	$2,002.20
Rate for Payer: UHCCP Medicaid	$2,002.20

POTASSIUM ACETATE 20 MEQ/100 ML (IVPB PREMIX)

Facility

$59.44

Service Code	NDC 09900001094
Hospital Charge Code	300104
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
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	$18.57
Rate for Payer: Amish Plain Church Group Commercial	$18.57
Rate for Payer: BCBS Complete	$11.00
Rate for Payer: BCBS MAPPO	$14.86
Rate for Payer: BCBS Trust/PPO	$48.87
Rate for Payer: BCN Commercial	$48.87
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: Mclaren Medicaid	$10.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.60
Rate for Payer: Meridian Medicaid	$11.00
Rate for Payer: MI Amish Medical Board Commercial	$17.09
Rate for Payer: Molina Medicare/Medicaid	$16.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.52
Rate for Payer: Nomi Health Commercial	$48.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.58
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 Choice Medicaid	$10.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.71
Rate for Payer: Priority Health Medicare	$15.01
Rate for Payer: Priority Health Narrow/Tiered Network	$41.37
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 Exchange	$14.86
Rate for Payer: UHC Medicaid	$10.48
Rate for Payer: UHC Medicare Advantage	$14.86
Rate for Payer: UHCCP Medicaid	$10.48
Rate for Payer: VA VA	$14.86
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$44.58

POTASSIUM ACETATE 20 MEQ/100 ML (IVPB PREMIX)

Facility

$59.44

Service Code	NDC 09900001094
Hospital Charge Code	300104
Hospital Revenue Code	250
Min. Negotiated Rate	$41.37
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$50.52
Rate for Payer: BCBS Trust/PPO	$49.09
Rate for Payer: BCN Commercial	$49.09
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: Opus (Opus Packaging Group) HMA	$44.58
Rate for Payer: PHP Commercial	$50.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.71
Rate for Payer: Priority Health Narrow/Tiered Network	$41.37
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 2 MEQ/ML INTRAVENOUS SOLUTION

Facility

$40.50

Service Code	NDC 00409329425
Hospital Charge Code	6420
Hospital Revenue Code	250
Min. Negotiated Rate	$7.14
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	$7.50
Rate for Payer: BCBS MAPPO	$10.12
Rate for Payer: BCBS Trust/PPO	$33.30
Rate for Payer: BCN Commercial	$33.30
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: Mclaren Medicaid	$7.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10.63
Rate for Payer: Meridian Medicaid	$7.50
Rate for Payer: MI Amish Medical Board Commercial	$11.64
Rate for Payer: Molina Medicare/Medicaid	$11.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.42
Rate for Payer: Nomi Health Commercial	$33.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.38
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 Choice Medicaid	$7.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.23
Rate for Payer: Priority Health Medicare	$10.23
Rate for Payer: Priority Health Narrow/Tiered Network	$28.19
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 Exchange	$10.12
Rate for Payer: UHC Medicaid	$7.14
Rate for Payer: UHC Medicare Advantage	$10.12
Rate for Payer: UHCCP Medicaid	$7.14
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

$21.76

Service Code	NDC 00409818301
Hospital Charge Code	6420
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
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	$4.03
Rate for Payer: BCBS MAPPO	$5.44
Rate for Payer: BCBS Trust/PPO	$17.89
Rate for Payer: BCN Commercial	$17.89
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: Mclaren Medicaid	$3.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.71
Rate for Payer: Meridian Medicaid	$4.03
Rate for Payer: MI Amish Medical Board Commercial	$6.26
Rate for Payer: Molina Medicare/Medicaid	$5.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.50
Rate for Payer: Nomi Health Commercial	$17.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.32
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 Choice Medicaid	$3.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.93
Rate for Payer: Priority Health Medicare	$5.49
Rate for Payer: Priority Health Narrow/Tiered Network	$15.14
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 Exchange	$5.44
Rate for Payer: UHC Medicaid	$3.84
Rate for Payer: UHC Medicare Advantage	$5.44
Rate for Payer: UHCCP Medicaid	$3.84
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

$40.50

Service Code	NDC 00409329425
Hospital Charge Code	6420
Hospital Revenue Code	250
Min. Negotiated Rate	$28.19
Max. Negotiated Rate	$36.45
Rate for Payer: Aetna Commercial	$34.42
Rate for Payer: BCBS Trust/PPO	$33.45
Rate for Payer: BCN Commercial	$33.45
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: Opus (Opus Packaging Group) HMA	$30.38
Rate for Payer: PHP Commercial	$34.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.23
Rate for Payer: Priority Health Narrow/Tiered Network	$28.19
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

$21.76

Service Code	NDC 00409818301
Hospital Charge Code	6420
Hospital Revenue Code	250
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$19.58
Rate for Payer: Aetna Commercial	$18.50
Rate for Payer: BCBS Trust/PPO	$17.97
Rate for Payer: BCN Commercial	$17.97
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: Opus (Opus Packaging Group) HMA	$16.32
Rate for Payer: PHP Commercial	$18.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.93
Rate for Payer: Priority Health Narrow/Tiered Network	$15.14
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

Know your out-of-pocket cost for care.

All Charges