|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$28.70
|
|
|
Service Code
|
NDC 60687062858
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$24.39
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.97
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$7.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.59
|
| Rate for Payer: BCN Commercial |
$23.59
|
| Rate for Payer: BCN Medicare Advantage |
$7.17
|
| Rate for Payer: Cash Price |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.17
|
| Rate for Payer: Healthscope Commercial |
$25.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.52
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.53
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.89
|
| 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: PACE Senior Care Partners |
$6.82
|
| Rate for Payer: PACE SWMI |
$7.17
|
| Rate for Payer: PHP Commercial |
$24.39
|
| Rate for Payer: PHP Medicare Advantage |
$7.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.97
|
| Rate for Payer: Priority Health Medicare |
$7.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$23.96
|
| Rate for Payer: UHC Exchange |
$7.17
|
| Rate for Payer: UHC Medicaid |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.17
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$7.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.52
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
NDC 00904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$21.73 |
| Rate for Payer: Aetna Commercial |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Commercial |
$19.95
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.11
|
| Rate for Payer: PHP Commercial |
$20.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Core |
$20.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 50268067415
|
| 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
|
$20.65
|
|
|
Service Code
|
NDC 00121168050
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$16.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$2.24
|
| Rate for Payer: BCBS MAPPO |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.02
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.07
|
| Rate for Payer: Mclaren Medicaid |
$2.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Medicaid |
$2.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.33
|
| 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: PACE Senior Care Partners |
$2.87
|
| Rate for Payer: PACE SWMI |
$3.02
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Medicare Advantage |
$3.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHC Medicaid |
$2.13
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UHCCP Medicaid |
$2.13
|
| Rate for Payer: VA VA |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 66689004750
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.82
|
| 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: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicaid |
$3.09
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$14.99
|
|
|
Service Code
|
NDC 71656002150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.19
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$14.99
|
|
|
Service Code
|
NDC 71656002150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.68
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.32
|
| Rate for Payer: BCN Commercial |
$12.32
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.04
|
| Rate for Payer: Priority Health Medicare |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.19
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicaid |
$2.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.33 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219011810
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219011801
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
NDC 65219011810
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$16.99
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$75.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicaid |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$16.18
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
NDC 65219011801
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$16.99
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$75.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicaid |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$16.18
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.33 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| 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 |
$55.51 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$65.87
|
| Rate for Payer: BCN Commercial |
$65.87
|
| 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: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.51
|
| 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 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 |
$12.33 |
| 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 |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| 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: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.35
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| 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 Exchange |
$17.48
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.48
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| 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
|
OP
|
$79.75
|
|
|
Service Code
|
NDC 00264763500
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.92
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.56
|
| Rate for Payer: BCN Commercial |
$65.56
|
| Rate for Payer: BCN Medicare Advantage |
$19.94
|
| 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: Health Alliance Plan Medicare Advantage |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Mclaren Medicaid |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.93
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: PACE Senior Care Partners |
$18.94
|
| Rate for Payer: PACE SWMI |
$19.94
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: PHP Medicare Advantage |
$19.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.38
|
| Rate for Payer: Priority Health Medicare |
$20.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: UHC Exchange |
$19.94
|
| Rate for Payer: UHC Medicaid |
$14.06
|
| Rate for Payer: UHC Medicare Advantage |
$19.94
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
| Rate for Payer: VA VA |
$19.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
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 |
$14.30 |
| 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 |
$16.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.28
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: BCN Commercial |
$17.28
|
| 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: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.56
|
| 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
|
$20.54
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.54
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS Complete |
$3.87
|
| Rate for Payer: BCBS MAPPO |
$5.13
|
| Rate for Payer: BCBS MAPPO |
$5.23
|
| Rate for Payer: BCBS Trust/PPO |
$16.89
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: BCN Medicare Advantage |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$5.13
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.74
|
| 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 |
$5.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.13
|
| 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: Mclaren Medicaid |
$3.69
|
| Rate for Payer: Mclaren Medicaid |
$3.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.39
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: Meridian Medicaid |
$3.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.65
|
| 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: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| 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 |
$17.46
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.13
|
| Rate for Payer: PHP Medicare Advantage |
$5.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.87
|
| Rate for Payer: Priority Health Medicare |
$5.28
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.56
|
| 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 Exchange |
$5.23
|
| Rate for Payer: UHC Exchange |
$5.13
|
| Rate for Payer: UHC Medicaid |
$3.69
|
| Rate for Payer: UHC Medicaid |
$3.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.13
|
| Rate for Payer: UHC Medicare Advantage |
$5.23
|
| Rate for Payer: UHCCP Medicaid |
$3.62
|
| Rate for Payer: UHCCP Medicaid |
$3.69
|
| 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
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338069504
|
| Hospital Charge Code |
11082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$39.52
|
| Rate for Payer: BCN Commercial |
$39.52
|
| 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: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.30
|
| 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 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
NDC 00990711609
|
| Hospital Charge Code |
11082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Medicare |
$29.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.89
|
| Rate for Payer: BCBS Complete |
$20.67
|
| Rate for Payer: BCBS MAPPO |
$27.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.79
|
| Rate for Payer: BCN Commercial |
$91.79
|
| Rate for Payer: BCN Medicare Advantage |
$27.91
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.91
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.74
|
| Rate for Payer: Mclaren Medicaid |
$19.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.31
|
| Rate for Payer: Meridian Medicaid |
$20.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Nomi Health Commercial |
$91.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.74
|
| Rate for Payer: PACE Senior Care Partners |
$26.52
|
| Rate for Payer: PACE SWMI |
$27.91
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.14
|
| Rate for Payer: Priority Health Medicare |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.71
|
| Rate for Payer: Railroad Medicare Medicare |
$27.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.25
|
| Rate for Payer: UHC Core |
$93.23
|
| Rate for Payer: UHC Exchange |
$27.91
|
| Rate for Payer: UHC Medicaid |
$19.68
|
| Rate for Payer: UHC Medicare Advantage |
$27.91
|
| Rate for Payer: UHCCP Medicaid |
$19.68
|
| Rate for Payer: VA VA |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.74
|
|
