|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818325
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329461
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818315
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
NDC 51754200401
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna American Axle |
$21.26
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.53
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna American Axle |
$21.26
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UMR Bronson Commercial |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.53
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338066904
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338066904
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 10 % ORAL LIQUID CUSTOM (BULK)
|
Facility
|
OP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
169415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna Medicare |
$318.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: BCBS Complete |
$254.82
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
POTASSIUM CHLORIDE 10 % ORAL LIQUID CUSTOM (BULK)
|
Facility
|
IP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
169415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$280.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
NDC 00904746180
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna Medicare |
$318.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: BCBS Complete |
$254.82
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$47.73
|
|
|
Service Code
|
NDC 60687062845
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.41
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: PHP Commercial |
$40.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.07
|
| Rate for Payer: UMR Bronson Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.80
|
|
|
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 |
$6.49 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$280.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.86
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.86
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health SBD |
$7.62
|
| Rate for Payer: UMR Bronson Commercial |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
NDC 60687034172
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna American Axle |
$40.62
|
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.62
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$43.75
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$56.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.12
|
| Rate for Payer: PHP Commercial |
$53.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.62
|
| Rate for Payer: Priority Health SBD |
$39.38
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: UMR Bronson Commercial |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
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 |
$4.48 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.86
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.86
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health SBD |
$7.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034171
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
