|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 60687034145
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health SBD |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 66689004799
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.42
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 81033022051
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna American Axle |
$5.16
|
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.16
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$7.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.75
|
| Rate for Payer: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.16
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034144
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 63739072450
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687034144
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| 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 |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$43.41
|
|
|
Service Code
|
NDC 00904706260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna American Axle |
$28.22
|
| Rate for Payer: Aetna Commercial |
$36.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.22
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.73
|
| Rate for Payer: Healthscope Commercial |
$39.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.90
|
| Rate for Payer: PHP Commercial |
$36.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.22
|
| Rate for Payer: Priority Health SBD |
$27.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 81033022015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna American Axle |
$5.16
|
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.16
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$7.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.75
|
| Rate for Payer: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.16
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.48
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna American Axle |
$13.31
|
| Rate for Payer: Aetna Commercial |
$17.41
|
| Rate for Payer: Aetna Medicare |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.31
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.41
|
| Rate for Payer: PHP Commercial |
$17.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| Rate for Payer: Priority Health SBD |
$12.90
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.36
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$35.08
|
|
|
Service Code
|
NDC 71656002130
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna American Axle |
$22.80
|
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.80
|
| Rate for Payer: BCBS Complete |
$14.03
|
| Rate for Payer: Cash Price |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.06
|
| Rate for Payer: Healthscope Commercial |
$31.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.82
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.80
|
| Rate for Payer: Priority Health SBD |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$12.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| 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 |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$47.73
|
|
|
Service Code
|
NDC 60687062814
|
| 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
|
IP
|
$35.08
|
|
|
Service Code
|
NDC 71656002130
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna American Axle |
$22.80
|
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.80
|
| Rate for Payer: Cash Price |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.06
|
| Rate for Payer: Healthscope Commercial |
$31.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.82
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.80
|
| Rate for Payer: Priority Health SBD |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 00121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 63739072401
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$40.63
|
|
|
Service Code
|
NDC 00904706262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna American Axle |
$26.41
|
| Rate for Payer: Aetna Commercial |
$34.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.41
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cofinity Commercial |
$28.44
|
| Rate for Payer: Cofinity Commercial |
$34.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.50
|
| Rate for Payer: Healthscope Commercial |
$36.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.54
|
| Rate for Payer: PHP Commercial |
$34.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.41
|
| Rate for Payer: Priority Health SBD |
$25.60
|
| Rate for Payer: UMR Bronson Commercial |
$17.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.47
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.77
|
|
|
Service Code
|
NDC 63739072450
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 00904746262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$47.51
|
|
|
Service Code
|
NDC 00904746260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$42.76 |
| Rate for Payer: Aetna American Axle |
$30.88
|
| Rate for Payer: Aetna Commercial |
$40.38
|
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.88
|
| Rate for Payer: BCBS Complete |
$19.00
|
| Rate for Payer: Cash Price |
$38.01
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.01
|
| Rate for Payer: Healthscope Commercial |
$42.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.38
|
| Rate for Payer: PHP Commercial |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.88
|
| Rate for Payer: Priority Health SBD |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.63
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$38.19
|
|
|
Service Code
|
NDC 60687034145
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health SBD |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$14.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$101.51
|
|
|
Service Code
|
NDC 72888004113
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.36 |
| Rate for Payer: Aetna American Axle |
$65.98
|
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.98
|
| Rate for Payer: BCBS Complete |
$40.60
|
| Rate for Payer: Cash Price |
$81.21
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.21
|
| Rate for Payer: Healthscope Commercial |
$91.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.28
|
| Rate for Payer: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.98
|
| Rate for Payer: Priority Health SBD |
$63.95
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.13
|
|
|
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
|
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
|
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
|
$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
|
|
