|
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 |
$26.67 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Aetna Medicare |
$39.33
|
| Rate for Payer: Aetna Medicare |
$19.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.22
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: BCBS MAPPO |
$20.98
|
| Rate for Payer: BCBS MAPPO |
$37.82
|
| Rate for Payer: BCBS MAPPO |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$124.36
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCBS Trust/PPO |
$68.98
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: BCN Commercial |
$68.98
|
| Rate for Payer: BCN Commercial |
$124.36
|
| Rate for Payer: BCN Medicare Advantage |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$18.74
|
| Rate for Payer: BCN Medicare Advantage |
$37.82
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.74
|
| 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 |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.23
|
| Rate for Payer: Mclaren Medicaid |
$26.67
|
| Rate for Payer: Mclaren Medicaid |
$14.79
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| 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 |
$22.03
|
| Rate for Payer: Meridian Medicaid |
$15.53
|
| Rate for Payer: Meridian Medicaid |
$28.00
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| 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 |
$24.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$124.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.45
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE Senior Care Partners |
$35.93
|
| Rate for Payer: PACE Senior Care Partners |
$19.93
|
| Rate for Payer: PACE SWMI |
$20.98
|
| Rate for Payer: PACE SWMI |
$18.74
|
| Rate for Payer: PACE SWMI |
$37.82
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.74
|
| Rate for Payer: PHP Medicare Advantage |
$37.82
|
| Rate for Payer: PHP Medicare Advantage |
$20.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$131.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: Priority Health Medicare |
$18.93
|
| Rate for Payer: Priority Health Medicare |
$38.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.28
|
| Rate for Payer: Railroad Medicare Medicare |
$18.74
|
| Rate for Payer: Railroad Medicare Medicare |
$20.98
|
| 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) |
$73.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.12
|
| Rate for Payer: UHC Core |
$126.31
|
| Rate for Payer: UHC Core |
$70.06
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: UHC Exchange |
$20.98
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Exchange |
$37.82
|
| Rate for Payer: UHC Medicaid |
$26.67
|
| Rate for Payer: UHC Medicaid |
$14.79
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.74
|
| Rate for Payer: UHC Medicare Advantage |
$37.82
|
| Rate for Payer: UHC Medicare Advantage |
$20.98
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: UHCCP Medicaid |
$26.67
|
| Rate for Payer: UHCCP Medicaid |
$14.79
|
| Rate for Payer: VA VA |
$37.82
|
| Rate for Payer: VA VA |
$20.98
|
| Rate for Payer: VA VA |
$18.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
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 |
$105.28 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: BCBS Trust/PPO |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$124.93
|
| Rate for Payer: BCBS Trust/PPO |
$69.30
|
| Rate for Payer: BCN Commercial |
$61.92
|
| Rate for Payer: BCN Commercial |
$124.93
|
| Rate for Payer: BCN Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| 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 |
$67.13
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| 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 |
$71.32
|
| Rate for Payer: Nomi Health Commercial |
$124.04
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$68.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$131.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| 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 |
$70.06
|
| Rate for Payer: UHC Core |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
| 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
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 00121168015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCN Commercial |
$16.46
|
| 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: Opus (Opus Packaging Group) HMA |
$14.95
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| 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
|
OP
|
$11.77
|
|
|
Service Code
|
NDC 71656002115
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$3.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.68
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: BCBS MAPPO |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$2.94
|
| Rate for Payer: Cash Price |
$9.42
|
| Rate for Payer: Cofinity Commercial |
$10.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$10.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.83
|
| Rate for Payer: Mclaren Medicaid |
$2.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.09
|
| Rate for Payer: Meridian Medicaid |
$2.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$9.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.83
|
| Rate for Payer: PACE Senior Care Partners |
$2.80
|
| Rate for Payer: PACE SWMI |
$2.94
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: PHP Medicare Advantage |
$2.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.24
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.19
|
| Rate for Payer: Railroad Medicare Medicare |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.36
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Medicaid |
$2.08
|
| Rate for Payer: UHC Medicare Advantage |
$2.94
|
| Rate for Payer: UHCCP Medicaid |
$2.08
|
| Rate for Payer: VA VA |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.83
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$22.76
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$18.80
|
| Rate for Payer: BCN Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 50268067411
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: Aetna Medicare |
$3.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.70
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$12.37
|
| Rate for Payer: BCN Commercial |
$12.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PACE Senior Care Partners |
$3.57
|
| Rate for Payer: PACE SWMI |
$3.76
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.09
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.24
|
| Rate for Payer: UHC Core |
$12.57
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UHC Medicaid |
$2.65
|
| Rate for Payer: UHC Medicare Advantage |
$3.76
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
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 |
$33.53 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$39.79
|
| Rate for Payer: BCN Commercial |
$39.79
|
| 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 |
$36.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.53
|
| 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 |
$36.13
|
|
|
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 |
$8.42 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCN Commercial |
$9.99
|
| 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 |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.42
|
| 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 |
$9.07
|
|
|
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 |
$8.49 |
| 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 |
$8.92
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.61
|
| Rate for Payer: BCN Commercial |
$39.61
|
| 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 |
$36.13
|
| Rate for Payer: Mclaren Medicaid |
$8.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$8.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| 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 Choice Medicaid |
$8.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.53
|
| 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 Exchange |
$12.04
|
| Rate for Payer: UHC Medicaid |
$8.49
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: UHCCP Medicaid |
$8.49
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 50268067415
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCN Commercial |
$12.43
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.24
|
| Rate for Payer: UHC Core |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
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 |
$4.26 |
| Max. Negotiated Rate |
$21.73 |
| 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 |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCN Commercial |
$19.85
|
| 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 |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.11
|
| 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 Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.01
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.81
|
| 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 Exchange |
$6.04
|
| Rate for Payer: UHC Medicaid |
$4.26
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: UHCCP Medicaid |
$4.26
|
| 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
|
$48.18
|
|
|
Service Code
|
NDC 60687034150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.53 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$39.79
|
| Rate for Payer: BCN Commercial |
$39.79
|
| 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 |
$36.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.53
|
| 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 |
$36.13
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$11.77
|
|
|
Service Code
|
NDC 71656002115
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.72
|
| Rate for Payer: BCN Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$9.42
|
| Rate for Payer: Cofinity Commercial |
$10.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.42
|
| Rate for Payer: Healthscope Commercial |
$10.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$9.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.83
|
| Rate for Payer: PHP Commercial |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.36
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.83
|
|
|
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 |
$19.98 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$24.39
|
| Rate for Payer: BCBS Trust/PPO |
$23.70
|
| Rate for Payer: BCN Commercial |
$23.70
|
| 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 |
$24.39
|
| Rate for Payer: Nomi Health Commercial |
$23.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.52
|
| Rate for Payer: PHP Commercial |
$24.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| 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
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 00121168050
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$18.59 |
| 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 |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.98
|
| 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 |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Mclaren Medicaid |
$3.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| 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 Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| 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 Exchange |
$5.16
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| 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
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.49 |
| 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 |
$8.92
|
| Rate for Payer: BCBS MAPPO |
$12.04
|
| Rate for Payer: BCBS Trust/PPO |
$39.61
|
| Rate for Payer: BCN Commercial |
$39.61
|
| 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 |
$36.13
|
| Rate for Payer: Mclaren Medicaid |
$8.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$8.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$39.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.13
|
| 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 Choice Medicaid |
$8.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.53
|
| 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 Exchange |
$12.04
|
| Rate for Payer: UHC Medicaid |
$8.49
|
| Rate for Payer: UHC Medicare Advantage |
$12.04
|
| Rate for Payer: UHCCP Medicaid |
$8.49
|
| Rate for Payer: VA VA |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$25.48
|
|
|
Service Code
|
NDC 00904746187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$22.93 |
| Rate for Payer: Aetna Commercial |
$21.66
|
| Rate for Payer: BCBS Trust/PPO |
$21.04
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$21.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.66
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.11
|
| Rate for Payer: PHP Commercial |
$21.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.42
|
| Rate for Payer: UHC Core |
$21.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$22.76
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: Meridian Medicaid |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.41
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.80
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicaid |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: UHCCP Medicaid |
$4.01
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 50268067411
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCN Commercial |
$12.43
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.24
|
| Rate for Payer: UHC Core |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.99
|
|
|
Service Code
|
NDC 60687062844
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$10.73
|
| Rate for Payer: BCN Commercial |
$10.73
|
| Rate for Payer: Cash Price |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$11.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.39
|
| Rate for Payer: Healthscope Commercial |
$11.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.04
|
| Rate for Payer: Nomi Health Commercial |
$10.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.74
|
| Rate for Payer: PHP Commercial |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.43
|
| Rate for Payer: UHC Core |
$10.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
|
|
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 |
$12.21 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCN Commercial |
$14.49
|
| 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 |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| 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 |
$13.15
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.99
|
|
|
Service Code
|
NDC 60687062844
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: Aetna Medicare |
$3.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| Rate for Payer: BCN Commercial |
$10.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.25
|
| Rate for Payer: Cash Price |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$11.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$11.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.41
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.04
|
| Rate for Payer: Nomi Health Commercial |
$10.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.74
|
| Rate for Payer: PACE Senior Care Partners |
$3.09
|
| Rate for Payer: PACE SWMI |
$3.25
|
| Rate for Payer: PHP Commercial |
$11.04
|
| Rate for Payer: PHP Medicare Advantage |
$3.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.30
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.43
|
| Rate for Payer: UHC Core |
$10.85
|
| Rate for Payer: UHC Exchange |
$3.25
|
| Rate for Payer: UHC Medicaid |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$3.25
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$3.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
|
|
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 |
$3.51 |
| 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 |
$3.69
|
| Rate for Payer: BCBS MAPPO |
$4.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$16.38
|
| 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: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| Rate for Payer: Meridian Medicaid |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.95
|
| 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 Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Medicare |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| 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 Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$3.51
|
| Rate for Payer: UHC Medicare Advantage |
$4.98
|
| Rate for Payer: UHCCP Medicaid |
$3.51
|
| 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
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| 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 |
$3.80
|
| Rate for Payer: BCBS MAPPO |
$5.13
|
| Rate for Payer: BCBS Trust/PPO |
$16.89
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: BCN Medicare Advantage |
$5.13
|
| 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 |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Mclaren Medicaid |
$3.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.39
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: PACE Senior Care Partners |
$4.88
|
| Rate for Payer: PACE SWMI |
$5.13
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Medicare Advantage |
$5.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: UHC Exchange |
$5.13
|
| Rate for Payer: UHC Medicaid |
$3.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.13
|
| Rate for Payer: UHCCP Medicaid |
$3.62
|
| Rate for Payer: VA VA |
$5.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$25.48
|
|
|
Service Code
|
NDC 00904746187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$22.93 |
| Rate for Payer: Aetna Commercial |
$21.66
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: BCBS MAPPO |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Medicare Advantage |
$6.37
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$21.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.37
|
| Rate for Payer: Healthscope Commercial |
$22.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: Meridian Medicaid |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.66
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.11
|
| Rate for Payer: PACE Senior Care Partners |
$6.05
|
| Rate for Payer: PACE SWMI |
$6.37
|
| Rate for Payer: PHP Commercial |
$21.66
|
| Rate for Payer: PHP Medicare Advantage |
$6.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.17
|
| Rate for Payer: Priority Health Medicare |
$6.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.42
|
| Rate for Payer: UHC Core |
$21.28
|
| Rate for Payer: UHC Exchange |
$6.37
|
| Rate for Payer: UHC Medicaid |
$4.49
|
| Rate for Payer: UHC Medicare Advantage |
$6.37
|
| Rate for Payer: UHCCP Medicaid |
$4.49
|
| Rate for Payer: VA VA |
$6.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.11
|
|
