|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$829.17
|
|
|
Service Code
|
NDC 63323-886-01
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$364.83 |
| Max. Negotiated Rate |
$746.25 |
| Rate for Payer: Aetna American Axle |
$538.96
|
| Rate for Payer: Aetna Commercial |
$704.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.96
|
| Rate for Payer: Cash Price |
$663.34
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$713.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.34
|
| Rate for Payer: Healthscope Commercial |
$746.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$580.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$704.79
|
| Rate for Payer: PHP Commercial |
$704.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.42
|
| Rate for Payer: Priority Health SBD |
$522.38
|
| Rate for Payer: UMR Bronson Commercial |
$364.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.88
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-72
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-72
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323-881-01
|
| 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
|
IP
|
$111.71
|
|
|
Service Code
|
NDC 63323-170-05
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.15 |
| 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: 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 |
$49.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$117.15
|
|
|
Service Code
|
NDC 63323-884-06
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$105.44 |
| Rate for Payer: Aetna American Axle |
$76.15
|
| Rate for Payer: Aetna Commercial |
$99.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.15
|
| Rate for Payer: Cash Price |
$93.72
|
| Rate for Payer: Cofinity Commercial |
$100.75
|
| Rate for Payer: Cofinity Commercial |
$82.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.72
|
| Rate for Payer: Healthscope Commercial |
$105.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.58
|
| Rate for Payer: PHP Commercial |
$99.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.00
|
| Rate for Payer: Priority Health SBD |
$73.80
|
| Rate for Payer: UMR Bronson Commercial |
$51.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.86
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-82
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 9900-0019-20
|
| Hospital Charge Code |
301290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 9900-0000-95
|
| Hospital Charge Code |
150946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna American Axle |
$11.05
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.45
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: UMR Bronson Commercial |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 0132-0201-40
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.57
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 0536-7415-51
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.57
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 9629512751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna American Axle |
$10.16
|
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.16
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.29
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: Priority Health SBD |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.72
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$37.23
|
|
|
Service Code
|
NDC 0132-0202-20
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Aetna American Axle |
$24.20
|
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.20
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$26.06
|
| Rate for Payer: Cofinity Commercial |
$32.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$33.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.65
|
| Rate for Payer: PHP Commercial |
$31.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.06
|
| Rate for Payer: Priority Health SBD |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.92
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$37.23
|
|
|
Service Code
|
NDC 132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Aetna American Axle |
$24.20
|
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.20
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$26.06
|
| Rate for Payer: Cofinity Commercial |
$32.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$33.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.65
|
| Rate for Payer: PHP Commercial |
$31.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.06
|
| Rate for Payer: Priority Health SBD |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.92
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$77.04
|
|
|
Service Code
|
NDC 46287-006-60
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$69.34 |
| Rate for Payer: Aetna American Axle |
$50.08
|
| Rate for Payer: Aetna Commercial |
$65.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.08
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cofinity Commercial |
$53.93
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.63
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.48
|
| Rate for Payer: PHP Commercial |
$65.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.93
|
| Rate for Payer: Priority Health SBD |
$48.54
|
| Rate for Payer: UMR Bronson Commercial |
$33.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.78
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$621.29
|
|
|
Service Code
|
NDC 46287-006-01
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.37 |
| Max. Negotiated Rate |
$559.16 |
| Rate for Payer: Aetna American Axle |
$403.84
|
| Rate for Payer: Aetna Commercial |
$528.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.84
|
| Rate for Payer: Cash Price |
$497.03
|
| Rate for Payer: Cofinity Commercial |
$434.90
|
| Rate for Payer: Cofinity Commercial |
$534.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.03
|
| Rate for Payer: Healthscope Commercial |
$559.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.10
|
| Rate for Payer: PHP Commercial |
$528.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.90
|
| Rate for Payer: Priority Health SBD |
$391.41
|
| Rate for Payer: UMR Bronson Commercial |
$273.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.97
|
|
|
SODIUM POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA
|
Facility
|
IP
|
$343.22
|
|
|
Service Code
|
NDC 46287-006-04
|
| Hospital Charge Code |
179841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$308.90 |
| Rate for Payer: Aetna American Axle |
$223.09
|
| Rate for Payer: Aetna Commercial |
$291.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.09
|
| Rate for Payer: Cash Price |
$274.58
|
| Rate for Payer: Cofinity Commercial |
$240.25
|
| Rate for Payer: Cofinity Commercial |
$295.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.58
|
| Rate for Payer: Healthscope Commercial |
$308.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.74
|
| Rate for Payer: PHP Commercial |
$291.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.25
|
| Rate for Payer: Priority Health SBD |
$216.23
|
| Rate for Payer: UMR Bronson Commercial |
$151.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.42
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
IP
|
$19.72
|
|
|
Service Code
|
NDC 0517-3120-25
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.76
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.80
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
OP
|
$19.72
|
|
|
Service Code
|
NDC 0517-3120-25
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.76
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.80
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457-163-00
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.10
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.10
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$344.35
|
|
|
Service Code
|
HCPCS J0208
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$309.92 |
| Rate for Payer: Aetna American Axle |
$223.83
|
| Rate for Payer: Aetna Commercial |
$292.70
|
| Rate for Payer: Aetna Medicare |
$100.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.24
|
| Rate for Payer: BCBS Complete |
$55.25
|
| Rate for Payer: BCBS MAPPO |
$96.19
|
| Rate for Payer: BCBS Trust/PPO |
$295.48
|
| Rate for Payer: BCN Medicare Advantage |
$96.19
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cofinity Commercial |
$296.14
|
| Rate for Payer: Cofinity Commercial |
$241.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.19
|
| Rate for Payer: Healthscope Commercial |
$309.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.26
|
| Rate for Payer: Mclaren Medicaid |
$52.61
|
| Rate for Payer: Mclaren Medicare |
$96.19
|
| Rate for Payer: Meridian Medicaid |
$55.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.70
|
| Rate for Payer: PACE Medicare |
$91.38
|
| Rate for Payer: PACE SWMI |
$96.19
|
| Rate for Payer: PHP Commercial |
$292.70
|
| Rate for Payer: PHP Medicare Advantage |
$96.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.50
|
| Rate for Payer: Priority Health Medicare |
$96.19
|
| Rate for Payer: Priority Health Narrow Network |
$226.00
|
| Rate for Payer: Priority Health SBD |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$96.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.19
|
| Rate for Payer: UHC Medicare Advantage |
$99.07
|
| Rate for Payer: UMR Bronson Commercial |
$127.41
|
| Rate for Payer: VA VA |
$96.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.26
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$344.35
|
|
|
Service Code
|
HCPCS J0208
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$309.92 |
| Rate for Payer: Aetna American Axle |
$223.83
|
| Rate for Payer: Aetna Commercial |
$292.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.83
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cofinity Commercial |
$241.04
|
| Rate for Payer: Cofinity Commercial |
$296.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.48
|
| Rate for Payer: Healthscope Commercial |
$309.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.70
|
| Rate for Payer: PHP Commercial |
$292.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.04
|
| Rate for Payer: Priority Health SBD |
$216.94
|
| Rate for Payer: UMR Bronson Commercial |
$151.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.26
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna American Axle |
$10.40
|
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health SBD |
$10.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$479.97
|
|
|
Service Code
|
NDC 0310-1110-30
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$431.97 |
| Rate for Payer: Aetna American Axle |
$311.98
|
| Rate for Payer: Aetna Commercial |
$407.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.98
|
| Rate for Payer: Cash Price |
$383.98
|
| Rate for Payer: Cofinity Commercial |
$335.98
|
| Rate for Payer: Cofinity Commercial |
$412.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.98
|
| Rate for Payer: Healthscope Commercial |
$431.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.97
|
| Rate for Payer: PHP Commercial |
$407.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.98
|
| Rate for Payer: Priority Health SBD |
$302.38
|
| Rate for Payer: UMR Bronson Commercial |
$211.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.98
|
|
