|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
NDC 50190014123
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna American Axle |
$1.84
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.84
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 83490020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna American Axle |
$2.24
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cofinity Advantage |
$2.41
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$3.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$1.79
|
| Rate for Payer: UHC Exchange |
$1.35
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.58
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 83490020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna American Axle |
$2.24
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.24
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cofinity Advantage |
$2.41
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$3.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.17
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.58
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Exchange |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.76
|
|
|
Service Code
|
NDC 81033001750
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna American Axle |
$11.54
|
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.54
|
| Rate for Payer: UHC Core |
$9.25
|
| Rate for Payer: UHC Exchange |
$6.98
|
| Rate for Payer: UMR Bronson Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.32
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.65
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.65
|
|
|
Service Code
|
NDC 60687083244
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$10.24
|
| Rate for Payer: UHC Exchange |
$7.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.76
|
|
|
Service Code
|
NDC 81033001750
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna American Axle |
$11.54
|
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.32
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
NDC 00904731680
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Advantage |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.74
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.18
|
| Rate for Payer: UHC Core |
$8.16
|
| Rate for Payer: UHC Exchange |
$6.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.65
|
|
|
Service Code
|
NDC 60687083216
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$10.24
|
| Rate for Payer: UHC Exchange |
$7.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.76
|
|
|
Service Code
|
NDC 81033001715
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna American Axle |
$11.54
|
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.54
|
| Rate for Payer: UHC Core |
$9.25
|
| Rate for Payer: UHC Exchange |
$6.98
|
| Rate for Payer: UMR Bronson Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.32
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.65
|
|
|
Service Code
|
NDC 60687083216
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.65
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.77
|
| Rate for Payer: UHC Core |
$10.24
|
| Rate for Payer: UHC Exchange |
$7.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 00904731680
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Advantage |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.74
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 00904731688
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Advantage |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.74
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.65
|
|
|
Service Code
|
NDC 60687083244
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.72
|
| Rate for Payer: Cofinity Advantage |
$13.76
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.74
|
| Rate for Payer: PHP Commercial |
$16.70
|
| Rate for Payer: Priority Health SBD |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.76
|
|
|
Service Code
|
NDC 81033001715
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna American Axle |
$11.54
|
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.32
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
NDC 00904731688
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Advantage |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.74
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.18
|
| Rate for Payer: UHC Core |
$8.16
|
| Rate for Payer: UHC Exchange |
$6.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 71351001101
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna Medicare |
$149.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: BCBS Complete |
$119.70
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.51
|
| Rate for Payer: UHC Core |
$155.91
|
| Rate for Payer: UHC Exchange |
$117.61
|
| Rate for Payer: UMR Bronson Commercial |
$110.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 71351001101
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UMR Bronson Commercial |
$131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna Medicare |
$149.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: BCBS Complete |
$119.70
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.51
|
| Rate for Payer: UHC Core |
$155.91
|
| Rate for Payer: UHC Exchange |
$117.61
|
| Rate for Payer: UMR Bronson Commercial |
$110.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UMR Bronson Commercial |
$131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$361.44
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$325.30 |
| Rate for Payer: Aetna American Axle |
$234.94
|
| Rate for Payer: Aetna Commercial |
$307.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.94
|
| Rate for Payer: Cash Price |
$289.15
|
| Rate for Payer: Cofinity Advantage |
$253.01
|
| Rate for Payer: Cofinity Commercial |
$310.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.15
|
| Rate for Payer: Healthscope Commercial |
$325.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.08
|
| Rate for Payer: PHP Commercial |
$307.22
|
| Rate for Payer: Priority Health SBD |
$227.71
|
| Rate for Payer: UMR Bronson Commercial |
$159.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.08
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$361.44
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.73 |
| Max. Negotiated Rate |
$325.30 |
| Rate for Payer: Aetna American Axle |
$234.94
|
| Rate for Payer: Aetna Commercial |
$307.22
|
| Rate for Payer: Aetna Medicare |
$180.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.94
|
| Rate for Payer: BCBS Complete |
$144.58
|
| Rate for Payer: Cash Price |
$289.15
|
| Rate for Payer: Cofinity Advantage |
$253.01
|
| Rate for Payer: Cofinity Commercial |
$310.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.15
|
| Rate for Payer: Healthscope Commercial |
$325.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.08
|
| Rate for Payer: PHP Commercial |
$307.22
|
| Rate for Payer: Priority Health SBD |
$227.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.94
|
| Rate for Payer: UHC Core |
$188.31
|
| Rate for Payer: UHC Exchange |
$142.05
|
| Rate for Payer: UMR Bronson Commercial |
$133.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.08
|
|
