|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
NDC 121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna American Axle |
$11.58
|
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.36
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 7135101101
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.13
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 6498010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$162.92
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 6954326810
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.13
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 486112501
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.17
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 3932810710
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.16 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.82
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.80
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$131.61
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$118.45 |
| Rate for Payer: Aetna American Axle |
$85.55
|
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: BCBS Trust/PPO |
$7.64
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$92.13
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.87
|
| Rate for Payer: PHP Commercial |
$111.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.13
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.71
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$32.04
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Aetna American Axle |
$20.83
|
| Rate for Payer: Aetna American Axle |
$85.55
|
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.83
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cofinity Commercial |
$92.13
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.87
|
| Rate for Payer: PHP Commercial |
$111.87
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.13
|
| Rate for Payer: Priority Health SBD |
$20.19
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.91
|
| Rate for Payer: UMR Bronson Commercial |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.03
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 8065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.46
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$65.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLN FOR WOUND VAC THERAPY ONLY
|
Facility
|
IP
|
$34.77
|
|
|
Service Code
|
NDC 3932806412
|
| Hospital Charge Code |
180209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna American Axle |
$22.60
|
| Rate for Payer: Aetna Commercial |
$29.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.60
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.55
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$21.91
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$34.77
|
|
|
Service Code
|
NDC 3932806412
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna American Axle |
$22.60
|
| Rate for Payer: Aetna Commercial |
$29.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.60
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.55
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$21.91
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$180.49
|
|
|
Service Code
|
NDC 3932806712
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$162.44 |
| Rate for Payer: Aetna American Axle |
$117.32
|
| Rate for Payer: Aetna Commercial |
$153.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.32
|
| Rate for Payer: Cash Price |
$144.39
|
| Rate for Payer: Cofinity Commercial |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$155.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.39
|
| Rate for Payer: Healthscope Commercial |
$162.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.42
|
| Rate for Payer: PHP Commercial |
$153.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.34
|
| Rate for Payer: Priority Health SBD |
$113.71
|
| Rate for Payer: UMR Bronson Commercial |
$79.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.37
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 9900-0018-64
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 0436-0672-16
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.04
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 0436-0936-16
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.04
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$34.77
|
|
|
Service Code
|
NDC 39328-063-25
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna American Axle |
$22.60
|
| Rate for Payer: Aetna Commercial |
$29.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.60
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$24.34
|
| Rate for Payer: Cofinity Commercial |
$29.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.55
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$21.91
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 9900-0018-66
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$62.91
|
|
|
Service Code
|
NDC 0436-0946-16
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna American Axle |
$40.89
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.89
|
| Rate for Payer: Cash Price |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$54.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.33
|
| Rate for Payer: Healthscope Commercial |
$56.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.47
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.04
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.18
|
|
|
SODIUM METABISULFITE (BULK) 100 % GRANULES
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 5155200699
|
| Hospital Charge Code |
23041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna American Axle |
$15.92
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.92
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.82
|
| Rate for Payer: PHP Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.15
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$97.24
|
|
|
Service Code
|
NDC 71288-202-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$87.52 |
| Rate for Payer: Aetna American Axle |
$63.21
|
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.21
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cofinity Commercial |
$68.07
|
| Rate for Payer: Cofinity Commercial |
$83.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.79
|
| Rate for Payer: Healthscope Commercial |
$87.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.65
|
| Rate for Payer: PHP Commercial |
$82.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.07
|
| Rate for Payer: Priority Health SBD |
$61.26
|
| Rate for Payer: UMR Bronson Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.93
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$134.04
|
|
|
Service Code
|
NDC 42571-265-75
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna American Axle |
$87.13
|
| Rate for Payer: Aetna Commercial |
$113.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.13
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Cofinity Commercial |
$93.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.23
|
| Rate for Payer: Healthscope Commercial |
$120.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.93
|
| Rate for Payer: PHP Commercial |
$113.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.83
|
| Rate for Payer: Priority Health SBD |
$84.45
|
| Rate for Payer: UMR Bronson Commercial |
$58.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.53
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021-310-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.47 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna American Axle |
$279.90
|
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.90
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$301.43
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.03
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.43
|
| Rate for Payer: Priority Health SBD |
$271.29
|
| Rate for Payer: UMR Bronson Commercial |
$189.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$981.19
|
|
|
Service Code
|
NDC 0187-4302-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$431.72 |
| Max. Negotiated Rate |
$883.07 |
| Rate for Payer: Aetna American Axle |
$637.77
|
| Rate for Payer: Aetna Commercial |
$834.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.77
|
| Rate for Payer: Cash Price |
$784.95
|
| Rate for Payer: Cofinity Commercial |
$686.83
|
| Rate for Payer: Cofinity Commercial |
$843.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.95
|
| Rate for Payer: Healthscope Commercial |
$883.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$834.01
|
| Rate for Payer: PHP Commercial |
$834.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.83
|
| Rate for Payer: Priority Health SBD |
$618.15
|
| Rate for Payer: UMR Bronson Commercial |
$431.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.89
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323-881-16
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$283.64 |
| Rate for Payer: Aetna American Axle |
$204.85
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.85
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$271.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.61
|
| Rate for Payer: Priority Health SBD |
$198.55
|
| Rate for Payer: UMR Bronson Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.37
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$111.71
|
|
|
Service Code
|
NDC 63323-170-05
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$100.54 |
| Rate for Payer: Aetna American Axle |
$72.61
|
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.61
|
| Rate for Payer: BCBS Complete |
$44.68
|
| Rate for Payer: Cash Price |
$89.37
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.37
|
| Rate for Payer: Healthscope Commercial |
$100.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.95
|
| Rate for Payer: PHP Commercial |
$94.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.20
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$41.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.78
|
|
