|
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 |
$1.00 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,356.10
|
|
|
Service Code
|
NDC 60258000316
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna American Axle |
$881.47
|
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.47
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| Rate for Payer: Cofinity Commercial |
$949.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$949.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$1,220.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,152.68
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$881.47
|
| Rate for Payer: Priority Health SBD |
$854.34
|
| Rate for Payer: UMR Bronson Commercial |
$596.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.08
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,356.10
|
|
|
Service Code
|
NDC 60258000316
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna American Axle |
$881.47
|
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna Medicare |
$678.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.47
|
| Rate for Payer: BCBS Complete |
$542.44
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| Rate for Payer: Cofinity Commercial |
$949.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$949.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$1,220.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,152.68
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$881.47
|
| Rate for Payer: Priority Health SBD |
$854.34
|
| Rate for Payer: UMR Bronson Commercial |
$501.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.08
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$578.01
|
|
|
Service Code
|
NDC 00121067616
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$520.21 |
| Rate for Payer: Aetna American Axle |
$375.71
|
| Rate for Payer: Aetna Commercial |
$491.31
|
| Rate for Payer: Aetna Medicare |
$289.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.71
|
| Rate for Payer: BCBS Complete |
$231.20
|
| Rate for Payer: Cash Price |
$462.41
|
| Rate for Payer: Cofinity Commercial |
$404.61
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.41
|
| Rate for Payer: Healthscope Commercial |
$520.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$491.31
|
| Rate for Payer: PHP Commercial |
$491.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.71
|
| Rate for Payer: Priority Health SBD |
$364.15
|
| Rate for Payer: UMR Bronson Commercial |
$213.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.51
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$578.01
|
|
|
Service Code
|
NDC 00121067616
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.32 |
| Max. Negotiated Rate |
$520.21 |
| Rate for Payer: Aetna American Axle |
$375.71
|
| Rate for Payer: Aetna Commercial |
$491.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.71
|
| Rate for Payer: Cash Price |
$462.41
|
| Rate for Payer: Cofinity Commercial |
$404.61
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.41
|
| Rate for Payer: Healthscope Commercial |
$520.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$491.31
|
| Rate for Payer: PHP Commercial |
$491.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.71
|
| Rate for Payer: Priority Health SBD |
$364.15
|
| Rate for Payer: UMR Bronson Commercial |
$254.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.51
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$291.65
|
|
|
Service Code
|
NDC 42543040701
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.91 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna American Axle |
$189.57
|
| Rate for Payer: Aetna Commercial |
$247.90
|
| Rate for Payer: Aetna Medicare |
$145.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.57
|
| Rate for Payer: BCBS Complete |
$116.66
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Commercial |
$204.16
|
| Rate for Payer: Cofinity Commercial |
$250.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: PHP Commercial |
$247.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.57
|
| Rate for Payer: Priority Health SBD |
$183.74
|
| Rate for Payer: UMR Bronson Commercial |
$107.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.74
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
NDC 00245007111
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.59
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UMR Bronson Commercial |
$277.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$291.65
|
|
|
Service Code
|
NDC 42543040701
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna American Axle |
$189.57
|
| Rate for Payer: Aetna Commercial |
$247.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.57
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Commercial |
$204.16
|
| Rate for Payer: Cofinity Commercial |
$250.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: PHP Commercial |
$247.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.57
|
| Rate for Payer: Priority Health SBD |
$183.74
|
| Rate for Payer: UMR Bronson Commercial |
$128.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.74
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$631.68
|
|
|
Service Code
|
NDC 00245007111
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.72 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna Medicare |
$315.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: BCBS Complete |
$252.67
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.59
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UMR Bronson Commercial |
$233.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
POTASSIUM HYDROXIDE (BULK) PELLET
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
NDC 62991303901
|
| Hospital Charge Code |
27652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$153.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
POTASSIUM HYDROXIDE (BULK) PELLET
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
NDC 62991303901
|
| Hospital Charge Code |
27652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$128.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,047.80
|
|
|
Service Code
|
NDC 71740011230
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.03 |
| Max. Negotiated Rate |
$943.02 |
| Rate for Payer: Aetna American Axle |
$681.07
|
| Rate for Payer: Aetna Commercial |
$890.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.07
|
| Rate for Payer: Cash Price |
$838.24
|
| Rate for Payer: Cofinity Commercial |
$733.46
|
| Rate for Payer: Cofinity Commercial |
$901.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.24
|
| Rate for Payer: Healthscope Commercial |
$943.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.63
|
| Rate for Payer: PHP Commercial |
$890.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.07
|
| Rate for Payer: Priority Health SBD |
$660.11
|
| Rate for Payer: UMR Bronson Commercial |
$461.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.85
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
OP
|
$987.21
|
|
|
Service Code
|
NDC 75834028030
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.27 |
| Max. Negotiated Rate |
$888.49 |
| Rate for Payer: Aetna American Axle |
$641.69
|
| Rate for Payer: Aetna Commercial |
$839.13
|
| Rate for Payer: Aetna Medicare |
$493.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.69
|
| Rate for Payer: BCBS Complete |
$394.88
|
| Rate for Payer: Cash Price |
$789.77
|
| Rate for Payer: Cofinity Commercial |
$691.05
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.77
|
| Rate for Payer: Healthscope Commercial |
$888.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.13
|
| Rate for Payer: PHP Commercial |
$839.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.69
|
| Rate for Payer: Priority Health SBD |
$621.94
|
| Rate for Payer: UMR Bronson Commercial |
$365.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.41
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$987.21
|
|
|
Service Code
|
NDC 75834028030
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.37 |
| Max. Negotiated Rate |
$888.49 |
| Rate for Payer: Aetna American Axle |
$641.69
|
| Rate for Payer: Aetna Commercial |
$839.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.69
|
| Rate for Payer: Cash Price |
$789.77
|
| Rate for Payer: Cofinity Commercial |
$691.05
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.77
|
| Rate for Payer: Healthscope Commercial |
$888.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.13
|
| Rate for Payer: PHP Commercial |
$839.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.69
|
| Rate for Payer: Priority Health SBD |
$621.94
|
| Rate for Payer: UMR Bronson Commercial |
$434.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.41
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,047.80
|
|
|
Service Code
|
NDC 71740011230
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.69 |
| Max. Negotiated Rate |
$943.02 |
| Rate for Payer: Aetna American Axle |
$681.07
|
| Rate for Payer: Aetna Commercial |
$890.63
|
| Rate for Payer: Aetna Medicare |
$523.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.07
|
| Rate for Payer: BCBS Complete |
$419.12
|
| Rate for Payer: Cash Price |
$838.24
|
| Rate for Payer: Cofinity Commercial |
$733.46
|
| Rate for Payer: Cofinity Commercial |
$901.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.24
|
| Rate for Payer: Healthscope Commercial |
$943.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.63
|
| Rate for Payer: PHP Commercial |
$890.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.07
|
| Rate for Payer: Priority Health SBD |
$660.11
|
| Rate for Payer: UMR Bronson Commercial |
$387.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.85
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 09900000984
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.27
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.32
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 09900000984
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.36
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.27
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.32
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.68 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna American Axle |
$280.21
|
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UMR Bronson Commercial |
$189.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.32
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna American Axle |
$280.21
|
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna Medicare |
$215.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UMR Bronson Commercial |
$159.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.32
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
NDC 46287002410
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna American Axle |
$280.21
|
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna Medicare |
$215.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UMR Bronson Commercial |
$159.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.32
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002410
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.68 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna American Axle |
$280.21
|
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UMR Bronson Commercial |
$189.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.32
|
|
|
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 |
$34.47 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna American Axle |
$50.91
|
| Rate for Payer: Aetna Commercial |
$66.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.91
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$54.83
|
| Rate for Payer: Cofinity Commercial |
$67.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.58
|
| Rate for Payer: PHP Commercial |
$66.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.91
|
| Rate for Payer: Priority Health SBD |
$49.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.75
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.68 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna American Axle |
$266.92
|
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: Priority Health SBD |
$258.70
|
| Rate for Payer: UMR Bronson Commercial |
$180.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.98
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.45
|
|
|
Service Code
|
NDC 00409729511
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$179.50 |
| Rate for Payer: Aetna American Axle |
$129.64
|
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.64
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$139.62
|
| Rate for Payer: Cofinity Commercial |
$171.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$179.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: PHP Commercial |
$169.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health SBD |
$125.65
|
| Rate for Payer: UMR Bronson Commercial |
$87.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.59
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$759.80
|
|
|
Service Code
|
NDC 65219005609
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$281.13 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna American Axle |
$493.87
|
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna Medicare |
$379.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: BCBS Complete |
$303.92
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
| Rate for Payer: UMR Bronson Commercial |
$281.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.85
|
|
