|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.21
|
|
|
Service Code
|
NDC 71656002115
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Aetna Commercial |
$10.38
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.82
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.04
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$10.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.38
|
| Rate for Payer: Nomi Health Commercial |
$10.01
|
| Rate for Payer: PACE Senior Care Partners |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health HMO/PPO |
$10.62
|
| Rate for Payer: Priority Health Medicare |
$3.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.74
|
| Rate for Payer: UHC Core |
$10.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UHC Medicare Advantage |
$3.05
|
| Rate for Payer: VA VA |
$3.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687034144
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$39.33
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.61
|
| Rate for Payer: BCN Commercial |
$37.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.04
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PACE Senior Care Partners |
$11.44
|
| Rate for Payer: PACE SWMI |
$12.04
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.04
|
| Rate for Payer: UHC Exchange |
$12.04
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034144
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.61
|
| Rate for Payer: BCN Commercial |
$37.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.04
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PACE Senior Care Partners |
$11.44
|
| Rate for Payer: PACE SWMI |
$12.04
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.04
|
| Rate for Payer: UHC Exchange |
$12.04
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
NDC 00904746187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: BCBS Trust/PPO |
$22.61
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034171
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.61
|
| Rate for Payer: BCN Commercial |
$37.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.04
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PACE Senior Care Partners |
$11.44
|
| Rate for Payer: PACE SWMI |
$12.04
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.04
|
| Rate for Payer: UHC Exchange |
$12.04
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
NDC 00904746187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.66
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS MAPPO |
$6.92
|
| Rate for Payer: BCBS Trust/PPO |
$22.77
|
| Rate for Payer: BCN Commercial |
$21.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.92
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.92
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Nomi Health Commercial |
$22.71
|
| Rate for Payer: PACE Senior Care Partners |
$6.58
|
| Rate for Payer: PACE SWMI |
$6.92
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health HMO/PPO |
$24.10
|
| Rate for Payer: Priority Health Medicare |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.56
|
| Rate for Payer: Railroad Medicare Medicare |
$6.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.92
|
| Rate for Payer: UHC Exchange |
$6.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.92
|
| Rate for Payer: VA VA |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS MAPPO |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.02
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: PACE Senior Care Partners |
$2.87
|
| Rate for Payer: PACE SWMI |
$3.02
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.02
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687034171
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$39.33
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.48
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$17.41
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$16.84
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.41
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PACE Senior Care Partners |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$17.41
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| Rate for Payer: Priority Health HMO/PPO |
$17.82
|
| Rate for Payer: Priority Health Medicare |
$5.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.72
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.02
|
| Rate for Payer: UHC Core |
$17.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Exchange |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.12
|
| Rate for Payer: VA VA |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.36
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.48
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.72
|
| Rate for Payer: BCN Commercial |
$15.83
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.41
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PHP Commercial |
$17.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| Rate for Payer: Priority Health HMO/PPO |
$17.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.02
|
| Rate for Payer: UHC Core |
$17.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.36
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.21
|
|
|
Service Code
|
NDC 71656002115
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Aetna Commercial |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCN Commercial |
$9.44
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$10.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.38
|
| Rate for Payer: Nomi Health Commercial |
$10.01
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health HMO/PPO |
$10.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.74
|
| Rate for Payer: UHC Core |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$28.70
|
|
|
Service Code
|
NDC 60687062858
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.97
|
| Rate for Payer: BCBS Complete |
$11.48
|
| Rate for Payer: BCBS MAPPO |
$7.18
|
| Rate for Payer: BCBS Trust/PPO |
$23.59
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.18
|
| 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: Health Alliance Plan Medicare Advantage |
$7.18
|
| Rate for Payer: Healthscope Commercial |
$25.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$23.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.82
|
| Rate for Payer: PACE SWMI |
$7.18
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.66
|
| Rate for Payer: Priority Health HMO/PPO |
$24.97
|
| Rate for Payer: Priority Health Medicare |
$7.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.23
|
| Rate for Payer: Railroad Medicare Medicare |
$7.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.18
|
| Rate for Payer: UHC Exchange |
$7.18
|
| Rate for Payer: UHC Medicare Advantage |
$7.18
|
| Rate for Payer: VA VA |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.52
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 71656002150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.05
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.03
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$2.44
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.01
|
| Rate for Payer: PACE Senior Care Partners |
$2.32
|
| Rate for Payer: PACE SWMI |
$2.44
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health HMO/PPO |
$8.50
|
| Rate for Payer: Priority Health Medicare |
$2.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$8.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.44
|
| Rate for Payer: UHC Exchange |
$2.44
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: VA VA |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.77
|
|
|
Service Code
|
NDC 71656002150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.98
|
| Rate for Payer: BCN Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.01
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health HMO/PPO |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$8.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 00121168015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: BCN Commercial |
$9.35
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
NDC 00121168015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.23
|
| Rate for Payer: BCBS Complete |
$7.97
|
| Rate for Payer: BCBS MAPPO |
$4.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.98
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.98
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.73
|
| Rate for Payer: PACE SWMI |
$4.98
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.95
|
| Rate for Payer: Priority Health HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Medicare |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.98
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicare Advantage |
$4.98
|
| Rate for Payer: VA VA |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
NDC 50268067411
|
| 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
|
$48.18
|
|
|
Service Code
|
NDC 60687034150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$39.33
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.89
|
| Rate for Payer: BCN Commercial |
$15.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.88
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.14
|
| Rate for Payer: UHC Exchange |
$5.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.14
|
| Rate for Payer: VA VA |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.77
|
| Rate for Payer: BCN Commercial |
$15.87
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$24.15
|
|
|
Service Code
|
NDC 00904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna Commercial |
$20.53
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCN Commercial |
$18.78
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| 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: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: PACE Senior Care Partners |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$20.53
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.70
|
| Rate for Payer: Priority Health HMO/PPO |
$21.01
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Core |
$20.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.04
|
| Rate for Payer: UHC Exchange |
$6.04
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: VA VA |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 66689004750
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCN Commercial |
$13.55
|
| 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: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.08
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
