|
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 WRAPPER
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
302029
|
|
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 WRAPPER
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
302029
|
|
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 WRAPPER
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
302029
|
|
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 WRAPPER
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
302029
|
|
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 WRAPPER
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
302029
|
|
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 WRAPPER
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
302029
|
|
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 FOR ORAL FEEDS
|
Facility
|
OP
|
$8.05
|
|
|
Service Code
|
NDC 09900000097
|
| Hospital Charge Code |
150947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna American Axle |
$5.23
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.23
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cofinity Advantage |
$5.63
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$7.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.84
|
| Rate for Payer: Priority Health SBD |
$5.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.23
|
| Rate for Payer: UHC Core |
$4.19
|
| Rate for Payer: UHC Exchange |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
SODIUM BICARBONATE 1 MEQ/ML FOR ORAL FEEDS
|
Facility
|
IP
|
$8.05
|
|
|
Service Code
|
NDC 09900000097
|
| Hospital Charge Code |
150947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna American Axle |
$5.23
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.23
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cofinity Advantage |
$5.63
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$7.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.84
|
| Rate for Payer: Priority Health SBD |
$5.07
|
| Rate for Payer: UMR Bronson Commercial |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.86
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Exchange |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna American Axle |
$47.73
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.73
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health SBD |
$46.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.73
|
| Rate for Payer: UHC Core |
$38.26
|
| Rate for Payer: UHC Exchange |
$28.86
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna American Axle |
$47.73
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.73
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health SBD |
$46.26
|
| Rate for Payer: UMR Bronson Commercial |
$32.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.41
|
| Rate for Payer: UHC Core |
$151.82
|
| Rate for Payer: UHC Exchange |
$114.52
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 64980052810
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00536104710
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.03
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 64980052810
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 00536104710
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.03
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.03
|
| Rate for Payer: UHC Core |
$134.68
|
| Rate for Payer: UHC Exchange |
$101.59
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
IP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna American Axle |
$47.73
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.73
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health SBD |
$46.26
|
| Rate for Payer: UMR Bronson Commercial |
$32.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
OP
|
$73.43
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.09 |
| Rate for Payer: Aetna American Axle |
$47.73
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.73
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.07
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health SBD |
$46.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.73
|
| Rate for Payer: UHC Core |
$38.26
|
| Rate for Payer: UHC Exchange |
$28.86
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.07
|
|
|
SODIUM BICARBONATE (BULK) POWDER
|
Facility
|
IP
|
$84.08
|
|
|
Service Code
|
NDC 00395268594
|
| Hospital Charge Code |
7310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$75.67 |
| Rate for Payer: Aetna American Axle |
$54.65
|
| Rate for Payer: Aetna Commercial |
$71.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.65
|
| Rate for Payer: Cash Price |
$67.26
|
| Rate for Payer: Cofinity Advantage |
$58.86
|
| Rate for Payer: Cofinity Commercial |
$72.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.26
|
| Rate for Payer: Healthscope Commercial |
$75.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.06
|
| Rate for Payer: PHP Commercial |
$71.47
|
| Rate for Payer: Priority Health SBD |
$52.97
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.06
|
|
|
SODIUM BICARBONATE (BULK) POWDER
|
Facility
|
OP
|
$84.08
|
|
|
Service Code
|
NDC 00395268594
|
| Hospital Charge Code |
7310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$75.67 |
| Rate for Payer: Aetna American Axle |
$54.65
|
| Rate for Payer: Aetna Commercial |
$71.47
|
| Rate for Payer: Aetna Medicare |
$42.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.65
|
| Rate for Payer: BCBS Complete |
$33.63
|
| Rate for Payer: Cash Price |
$67.26
|
| Rate for Payer: Cofinity Advantage |
$58.86
|
| Rate for Payer: Cofinity Commercial |
$72.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.26
|
| Rate for Payer: Healthscope Commercial |
$75.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.06
|
| Rate for Payer: PHP Commercial |
$71.47
|
| Rate for Payer: Priority Health SBD |
$52.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.65
|
| Rate for Payer: UHC Core |
$43.81
|
| Rate for Payer: UHC Exchange |
$33.04
|
| Rate for Payer: UMR Bronson Commercial |
$31.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.06
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$48.15
|
|
|
Service Code
|
NDC 00536122497
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Aetna American Axle |
$31.30
|
| Rate for Payer: Aetna Commercial |
$40.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.30
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cofinity Advantage |
$33.70
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.52
|
| Rate for Payer: Healthscope Commercial |
$43.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.11
|
| Rate for Payer: PHP Commercial |
$40.93
|
| Rate for Payer: Priority Health SBD |
$30.33
|
| Rate for Payer: UMR Bronson Commercial |
$21.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.11
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$48.15
|
|
|
Service Code
|
NDC 00536122497
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Aetna American Axle |
$31.30
|
| Rate for Payer: Aetna Commercial |
$40.93
|
| Rate for Payer: Aetna Medicare |
$24.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.30
|
| Rate for Payer: BCBS Complete |
$19.26
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cofinity Advantage |
$33.70
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.52
|
| Rate for Payer: Healthscope Commercial |
$43.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.11
|
| Rate for Payer: PHP Commercial |
$40.93
|
| Rate for Payer: Priority Health SBD |
$30.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.30
|
| Rate for Payer: UHC Core |
$25.09
|
| Rate for Payer: UHC Exchange |
$18.92
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.11
|
|
