|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.86
|
|
|
Service Code
|
NDC 81665020005
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$59.27 |
| Rate for Payer: Aetna American Axle |
$42.81
|
| Rate for Payer: Aetna Commercial |
$55.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.81
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Advantage |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: PHP Commercial |
$55.98
|
| Rate for Payer: Priority Health SBD |
$41.49
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.40
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$10.78
|
| Rate for Payer: UHC Exchange |
$8.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.14
|
| Rate for Payer: UHC Core |
$18.55
|
| Rate for Payer: UHC Exchange |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$10.78
|
| Rate for Payer: UHC Exchange |
$8.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.14
|
| Rate for Payer: UHC Core |
$18.55
|
| Rate for Payer: UHC Exchange |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.81
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna American Axle |
$15.48
|
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.48
|
| Rate for Payer: BCBS Complete |
$9.52
|
| Rate for Payer: Cash Price |
$19.05
|
| Rate for Payer: Cofinity Advantage |
$16.67
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.86
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: Priority Health SBD |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.86
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.04
|
|
|
Service Code
|
NDC 72572074001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Advantage |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.03
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$14.61
|
| Rate for Payer: UHC Exchange |
$11.02
|
| Rate for Payer: UMR Bronson Commercial |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.03
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.04
|
|
|
Service Code
|
NDC 72572074001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Advantage |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.03
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.03
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.14
|
| Rate for Payer: UHC Core |
$18.55
|
| Rate for Payer: UHC Exchange |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
NDC 81665020005
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$59.27 |
| Rate for Payer: Aetna American Axle |
$42.81
|
| Rate for Payer: Aetna Commercial |
$55.98
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.81
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Advantage |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: PHP Commercial |
$55.98
|
| Rate for Payer: Priority Health SBD |
$41.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$34.31
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UMR Bronson Commercial |
$24.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.40
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.86
|
|
|
Service Code
|
NDC 81665020001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$59.27 |
| Rate for Payer: Aetna American Axle |
$42.81
|
| Rate for Payer: Aetna Commercial |
$55.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.81
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Advantage |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: PHP Commercial |
$55.98
|
| Rate for Payer: Priority Health SBD |
$41.49
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.40
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$102.80
|
|
|
Service Code
|
NDC 63323008950
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.23 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: Aetna American Axle |
$66.82
|
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.82
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cofinity Advantage |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$92.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.10
|
| Rate for Payer: PHP Commercial |
$87.38
|
| Rate for Payer: Priority Health SBD |
$64.76
|
| Rate for Payer: UMR Bronson Commercial |
$45.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.10
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna American Axle |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.19
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
NDC 81665020001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$59.27 |
| Rate for Payer: Aetna American Axle |
$42.81
|
| Rate for Payer: Aetna Commercial |
$55.98
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.81
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Advantage |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: PHP Commercial |
$55.98
|
| Rate for Payer: Priority Health SBD |
$41.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$34.31
|
| Rate for Payer: UHC Exchange |
$25.88
|
| Rate for Payer: UMR Bronson Commercial |
$24.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.40
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.04
|
|
|
Service Code
|
NDC 72572074020
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Advantage |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.03
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.03
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$102.80
|
|
|
Service Code
|
NDC 63323008950
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.04 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: Aetna American Axle |
$66.82
|
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: Aetna Medicare |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.82
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cofinity Advantage |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$92.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.10
|
| Rate for Payer: PHP Commercial |
$87.38
|
| Rate for Payer: Priority Health SBD |
$64.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.82
|
| Rate for Payer: UHC Core |
$53.56
|
| Rate for Payer: UHC Exchange |
$40.40
|
| Rate for Payer: UMR Bronson Commercial |
$38.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.10
|
|
