|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.85
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$54.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.48
|
| 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: Health Alliance Plan Medicare Advantage |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.61
|
| Rate for Payer: PACE SWMI |
$17.48
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Medicare Advantage |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.48
|
| Rate for Payer: UHC Exchange |
$17.48
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
NDC 00264763500
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.84
|
| Rate for Payer: Priority Health HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.08
|
| Rate for Payer: BCN Commercial |
$15.87
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: UHC Core |
$17.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.69
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$18.83 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$5.13
|
| Rate for Payer: BCBS MAPPO |
$5.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.89
|
| Rate for Payer: BCN Commercial |
$16.27
|
| Rate for Payer: BCN Commercial |
$15.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$5.13
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.23
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.97
|
| Rate for Payer: PACE Senior Care Partners |
$4.88
|
| Rate for Payer: PACE SWMI |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.13
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: PHP Medicare Advantage |
$5.13
|
| Rate for Payer: PHP Medicare Advantage |
$5.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health HMO/PPO |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$5.28
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Core |
$17.47
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.13
|
| Rate for Payer: UHC Exchange |
$5.13
|
| Rate for Payer: UHC Exchange |
$5.23
|
| Rate for Payer: UHC Medicare Advantage |
$5.13
|
| Rate for Payer: UHC Medicare Advantage |
$5.23
|
| Rate for Payer: VA VA |
$5.13
|
| Rate for Payer: VA VA |
$5.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338069504
|
| Hospital Charge Code |
11082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.95
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$39.34
|
| Rate for Payer: BCN Commercial |
$37.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.96
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: PACE Senior Care Partners |
$11.36
|
| Rate for Payer: PACE SWMI |
$11.96
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.96
|
| Rate for Payer: UHC Exchange |
$11.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.96
|
| Rate for Payer: VA VA |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338069504
|
| Hospital Charge Code |
11082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$39.06
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338080704
|
| Hospital Charge Code |
9796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$39.06
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338080704
|
| Hospital Charge Code |
9796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.95
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$39.34
|
| Rate for Payer: BCN Commercial |
$37.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.96
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: PACE Senior Care Partners |
$11.36
|
| Rate for Payer: PACE SWMI |
$11.96
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.96
|
| Rate for Payer: UHC Exchange |
$11.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.96
|
| Rate for Payer: VA VA |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$311.60
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: Aetna Medicare |
$81.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.38
|
| Rate for Payer: BCBS Complete |
$124.64
|
| Rate for Payer: BCBS MAPPO |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$256.17
|
| Rate for Payer: BCN Commercial |
$242.27
|
| Rate for Payer: BCN Medicare Advantage |
$77.90
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.86
|
| Rate for Payer: Nomi Health Commercial |
$255.51
|
| Rate for Payer: PACE Senior Care Partners |
$74.00
|
| Rate for Payer: PACE SWMI |
$77.90
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: PHP Medicare Advantage |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.54
|
| Rate for Payer: Priority Health HMO/PPO |
$271.09
|
| Rate for Payer: Priority Health Medicare |
$78.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.77
|
| Rate for Payer: Railroad Medicare Medicare |
$77.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.21
|
| Rate for Payer: UHC Core |
$260.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.90
|
| Rate for Payer: UHC Exchange |
$77.90
|
| Rate for Payer: UHC Medicare Advantage |
$77.90
|
| Rate for Payer: VA VA |
$77.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.70
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$212.93
|
| Rate for Payer: BCN Commercial |
$201.58
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: BCBS Trust/PPO |
$219.46
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$69.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.02
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS MAPPO |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$221.02
|
| Rate for Payer: BCN Commercial |
$209.03
|
| Rate for Payer: BCN Medicare Advantage |
$67.21
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.21
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: PACE Senior Care Partners |
$63.85
|
| Rate for Payer: PACE SWMI |
$67.21
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: PHP Medicare Advantage |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO |
$233.90
|
| Rate for Payer: Priority Health Medicare |
$67.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.13
|
| Rate for Payer: Railroad Medicare Medicare |
$67.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.21
|
| Rate for Payer: UHC Exchange |
$67.21
|
| Rate for Payer: UHC Medicare Advantage |
$67.21
|
| Rate for Payer: VA VA |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 00245531689
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2.34
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.46 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: BCBS Trust/PPO |
$197.75
|
| Rate for Payer: BCN Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: Nomi Health Commercial |
$198.65
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: Priority Health HMO/PPO |
$210.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.18
|
| Rate for Payer: UHC Core |
$202.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.69
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.17
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$172.10
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PACE Senior Care Partners |
$52.57
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Medicare |
$55.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: Railroad Medicare Medicare |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.34
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| Rate for Payer: VA VA |
$55.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.69
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 00245531689
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.95 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$67.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.52
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: BCBS MAPPO |
$65.21
|
| Rate for Payer: BCBS Trust/PPO |
$214.44
|
| Rate for Payer: BCN Commercial |
$202.81
|
| Rate for Payer: BCN Medicare Advantage |
$65.21
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.21
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: PACE Senior Care Partners |
$61.95
|
| Rate for Payer: PACE SWMI |
$65.21
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$65.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.21
|
| Rate for Payer: UHC Exchange |
$65.21
|
| Rate for Payer: UHC Medicare Advantage |
$65.21
|
| Rate for Payer: VA VA |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$311.60
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.54 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: BCBS Trust/PPO |
$254.36
|
| Rate for Payer: BCN Commercial |
$240.80
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.86
|
| Rate for Payer: Nomi Health Commercial |
$255.51
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.54
|
| Rate for Payer: Priority Health HMO/PPO |
$271.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.21
|
| Rate for Payer: UHC Core |
$260.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.70
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687046611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687046611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.76
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2.11
|
| Rate for Payer: Priority Health Medicare |
$0.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.53 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: Aetna Medicare |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.70
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS MAPPO |
$60.56
|
| Rate for Payer: BCBS Trust/PPO |
$199.15
|
| Rate for Payer: BCN Commercial |
$188.35
|
| Rate for Payer: BCN Medicare Advantage |
$60.56
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.56
|
| Rate for Payer: Healthscope Commercial |
$218.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: Nomi Health Commercial |
$198.65
|
| Rate for Payer: PACE Senior Care Partners |
$57.53
|
| Rate for Payer: PACE SWMI |
$60.56
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: PHP Medicare Advantage |
$60.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: Priority Health HMO/PPO |
$210.76
|
| Rate for Payer: Priority Health Medicare |
$61.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.31
|
| Rate for Payer: Railroad Medicare Medicare |
$60.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.18
|
| Rate for Payer: UHC Core |
$202.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.56
|
| Rate for Payer: UHC Exchange |
$60.56
|
| Rate for Payer: UHC Medicare Advantage |
$60.56
|
| Rate for Payer: VA VA |
$60.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.69
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78.33
|
|
|
Service Code
|
NDC 65219005209
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$66.58
|
| Rate for Payer: BCBS Trust/PPO |
$63.94
|
| Rate for Payer: BCN Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$67.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.58
|
| Rate for Payer: Nomi Health Commercial |
$64.23
|
| Rate for Payer: PHP Commercial |
$66.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.91
|
| Rate for Payer: Priority Health HMO/PPO |
$68.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.93
|
| Rate for Payer: UHC Core |
$65.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.75
|
|
