|
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
|
|
|
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 FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna American Axle |
$89.69
|
| Rate for Payer: Aetna American Axle |
$22.93
|
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.93
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Advantage |
$24.69
|
| Rate for Payer: Cofinity Advantage |
$96.59
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: Priority Health SBD |
$22.22
|
| Rate for Payer: Priority Health SBD |
$86.93
|
| Rate for Payer: UMR Bronson Commercial |
$60.71
|
| Rate for Payer: UMR Bronson Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna American Axle |
$89.69
|
| Rate for Payer: Aetna American Axle |
$22.93
|
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna Medicare |
$68.99
|
| Rate for Payer: Aetna Medicare |
$17.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.93
|
| Rate for Payer: BCBS Complete |
$14.11
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCN Commercial |
$7.16
|
| Rate for Payer: BCN Commercial |
$7.16
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Advantage |
$96.59
|
| Rate for Payer: Cofinity Advantage |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: Priority Health SBD |
$86.93
|
| Rate for Payer: Priority Health SBD |
$22.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.65
|
| Rate for Payer: UHC Core |
$3.65
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$51.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Advantage |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$65.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Advantage |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.00
|
| Rate for Payer: UHC Core |
$77.75
|
| Rate for Payer: UHC Exchange |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLN FOR WOUND VAC THERAPY ONLY
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
180209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLN FOR WOUND VAC THERAPY ONLY
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
180209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.13
|
| Rate for Payer: UHC Core |
$24.15
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UMR Bronson Commercial |
$17.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$66.22
|
|
|
Service Code
|
NDC 00436067216
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 09900001864
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.80
|
| Rate for Payer: UHC Core |
$6.25
|
| Rate for Payer: UHC Exchange |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$66.22
|
|
|
Service Code
|
NDC 00436067216
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.04
|
| Rate for Payer: UHC Core |
$34.50
|
| Rate for Payer: UHC Exchange |
$26.02
|
| Rate for Payer: UMR Bronson Commercial |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 09900001864
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
IP
|
$165.19
|
|
|
Service Code
|
NDC 39328006712
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Aetna American Axle |
$107.37
|
| Rate for Payer: Aetna Commercial |
$140.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: Cash Price |
$132.15
|
| Rate for Payer: Cofinity Advantage |
$115.63
|
| Rate for Payer: Cofinity Commercial |
$142.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.15
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.89
|
| Rate for Payer: PHP Commercial |
$140.41
|
| Rate for Payer: Priority Health SBD |
$104.07
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.89
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.13
|
| Rate for Payer: UHC Core |
$24.15
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UMR Bronson Commercial |
$17.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.125 % SOLUTION
|
Facility
|
OP
|
$165.19
|
|
|
Service Code
|
NDC 39328006712
|
| Hospital Charge Code |
76720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Aetna American Axle |
$107.37
|
| Rate for Payer: Aetna Commercial |
$140.41
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: BCBS Complete |
$66.08
|
| Rate for Payer: Cash Price |
$132.15
|
| Rate for Payer: Cofinity Advantage |
$115.63
|
| Rate for Payer: Cofinity Commercial |
$142.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.15
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.89
|
| Rate for Payer: PHP Commercial |
$140.41
|
| Rate for Payer: Priority Health SBD |
$104.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.37
|
| Rate for Payer: UHC Core |
$86.06
|
| Rate for Payer: UHC Exchange |
$64.92
|
| Rate for Payer: UMR Bronson Commercial |
$61.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.89
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
OP
|
$66.22
|
|
|
Service Code
|
NDC 00436093616
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.04
|
| Rate for Payer: UHC Core |
$34.50
|
| Rate for Payer: UHC Exchange |
$26.02
|
| Rate for Payer: UMR Bronson Commercial |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Advantage |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.13
|
| Rate for Payer: UHC Core |
$24.15
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UMR Bronson Commercial |
$17.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION
|
Facility
|
IP
|
$66.22
|
|
|
Service Code
|
NDC 00436093616
|
| Hospital Charge Code |
15950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$66.22
|
|
|
Service Code
|
NDC 00436094616
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
OP
|
$66.22
|
|
|
Service Code
|
NDC 00436094616
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.04
|
| Rate for Payer: UHC Core |
$34.50
|
| Rate for Payer: UHC Exchange |
$26.02
|
| Rate for Payer: UMR Bronson Commercial |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 09900001866
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.80
|
| Rate for Payer: UHC Core |
$6.25
|
| Rate for Payer: UHC Exchange |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM HYPOCHLORITE 0.5 % SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 09900001866
|
| Hospital Charge Code |
2110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
SODIUM METABISULFITE (BULK) 100 % GRANULES
|
Facility
|
OP
|
$24.50
|
|
|
Service Code
|
NDC 51552006909
|
| Hospital Charge Code |
23041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna American Axle |
$15.93
|
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Advantage |
$17.15
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.38
|
| Rate for Payer: PHP Commercial |
$20.82
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.93
|
| Rate for Payer: UHC Core |
$12.76
|
| Rate for Payer: UHC Exchange |
$9.63
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
