|
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
|
|
|
SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$351.45
|
|
|
Service Code
|
NDC 60267031110
|
| Hospital Charge Code |
24049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.64 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Advantage |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$316.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: UMR Bronson Commercial |
$154.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$351.45
|
|
|
Service Code
|
NDC 60267031110
|
| Hospital Charge Code |
24049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.04 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna Medicare |
$175.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: BCBS Complete |
$140.58
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Advantage |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$316.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.44
|
| Rate for Payer: UHC Core |
$183.11
|
| Rate for Payer: UHC Exchange |
$138.12
|
| Rate for Payer: UMR Bronson Commercial |
$130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
IP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.68 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna American Axle |
$454.53
|
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.53
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Advantage |
$489.50
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: Priority Health SBD |
$440.55
|
| Rate for Payer: UMR Bronson Commercial |
$307.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
OP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Aetna American Axle |
$454.53
|
| Rate for Payer: Aetna Commercial |
$594.39
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Advantage |
$489.50
|
| Rate for Payer: Cofinity Commercial |
$601.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$629.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.46
|
| Rate for Payer: Mclaren Medicaid |
$2.17
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$6.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$594.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.04
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$440.55
|
| Rate for Payer: Priority Health Tiered Network |
$5.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$258.73
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.46
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
NDC 71288020202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Advantage |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.47 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna American Axle |
$279.90
|
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.90
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Advantage |
$301.43
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.96
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health SBD |
$271.29
|
| Rate for Payer: UMR Bronson Commercial |
$189.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$134.04
|
|
|
Service Code
|
NDC 42571026575
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna American Axle |
$87.13
|
| Rate for Payer: Aetna Commercial |
$113.93
|
| Rate for Payer: Aetna Medicare |
$67.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.13
|
| Rate for Payer: BCBS Complete |
$53.62
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Cofinity Advantage |
$93.83
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.23
|
| Rate for Payer: Healthscope Commercial |
$120.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.53
|
| Rate for Payer: PHP Commercial |
$113.93
|
| Rate for Payer: Priority Health SBD |
$84.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.13
|
| Rate for Payer: UHC Core |
$69.83
|
| Rate for Payer: UHC Exchange |
$52.68
|
| Rate for Payer: UMR Bronson Commercial |
$49.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.53
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$430.62
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.33 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna American Axle |
$279.90
|
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: Aetna Medicare |
$215.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.90
|
| Rate for Payer: BCBS Complete |
$172.25
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Advantage |
$301.43
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.96
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health SBD |
$271.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.90
|
| Rate for Payer: UHC Core |
$224.35
|
| Rate for Payer: UHC Exchange |
$169.23
|
| Rate for Payer: UMR Bronson Commercial |
$159.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
NDC 71288020202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Advantage |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$21.56
|
| Rate for Payer: UHC Exchange |
$16.27
|
| Rate for Payer: UMR Bronson Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$134.04
|
|
|
Service Code
|
NDC 42571026575
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna American Axle |
$87.13
|
| Rate for Payer: Aetna Commercial |
$113.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.13
|
| Rate for Payer: Cash Price |
$107.23
|
| Rate for Payer: Cofinity Advantage |
$93.83
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.23
|
| Rate for Payer: Healthscope Commercial |
$120.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.53
|
| Rate for Payer: PHP Commercial |
$113.93
|
| Rate for Payer: Priority Health SBD |
$84.45
|
| Rate for Payer: UMR Bronson Commercial |
$58.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.53
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$122.66
|
|
|
Service Code
|
NDC 00517730525
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Advantage |
$85.86
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.13
|
| Rate for Payer: Healthscope Commercial |
$110.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$667.73
|
|
|
Service Code
|
NDC 63323088601
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$600.96 |
| Rate for Payer: Aetna American Axle |
$434.02
|
| Rate for Payer: Aetna Commercial |
$567.57
|
| Rate for Payer: Aetna Medicare |
$333.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.02
|
| Rate for Payer: BCBS Complete |
$267.09
|
| Rate for Payer: Cash Price |
$534.18
|
| Rate for Payer: Cofinity Advantage |
$467.41
|
| Rate for Payer: Cofinity Commercial |
$574.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.18
|
| Rate for Payer: Healthscope Commercial |
$600.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$467.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$534.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.80
|
| Rate for Payer: PHP Commercial |
$567.57
|
| Rate for Payer: Priority Health SBD |
$420.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.02
|
| Rate for Payer: UHC Core |
$347.89
|
| Rate for Payer: UHC Exchange |
$262.42
|
| Rate for Payer: UMR Bronson Commercial |
$247.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.80
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$122.66
|
|
|
Service Code
|
NDC 00517730501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna Medicare |
$61.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: BCBS Complete |
$49.06
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Advantage |
$85.86
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.13
|
| Rate for Payer: Healthscope Commercial |
$110.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.73
|
| Rate for Payer: UHC Core |
$63.91
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UMR Bronson Commercial |
$45.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna American Axle |
$186.15
|
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: Aetna Medicare |
$143.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.15
|
| Rate for Payer: BCBS Complete |
$114.55
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Advantage |
$200.47
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: Priority Health SBD |
$180.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.15
|
| Rate for Payer: UHC Core |
$149.20
|
| Rate for Payer: UHC Exchange |
$112.55
|
| Rate for Payer: UMR Bronson Commercial |
$105.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.96
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna American Axle |
$61.07
|
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.07
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Advantage |
$65.77
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: Priority Health SBD |
$59.19
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Advantage |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.05
|
| Rate for Payer: UHC Core |
$123.48
|
| Rate for Payer: UHC Exchange |
$93.14
|
| Rate for Payer: UMR Bronson Commercial |
$87.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$182.05
|
|
|
Service Code
|
NDC 00517731525
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: BCBS Complete |
$72.82
|
| Rate for Payer: Cash Price |
$145.64
|
| Rate for Payer: Cofinity Advantage |
$127.44
|
| Rate for Payer: Cofinity Commercial |
$156.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.64
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.54
|
| Rate for Payer: PHP Commercial |
$154.74
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.33
|
| Rate for Payer: UHC Core |
$94.85
|
| Rate for Payer: UHC Exchange |
$71.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.54
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$182.05
|
|
|
Service Code
|
NDC 00517731501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: BCBS Complete |
$72.82
|
| Rate for Payer: Cash Price |
$145.64
|
| Rate for Payer: Cofinity Advantage |
$127.44
|
| Rate for Payer: Cofinity Commercial |
$156.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.64
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.54
|
| Rate for Payer: PHP Commercial |
$154.74
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.33
|
| Rate for Payer: UHC Core |
$94.85
|
| Rate for Payer: UHC Exchange |
$71.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.54
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.28 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Advantage |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: UMR Bronson Commercial |
$104.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.96
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Aetna American Axle |
$61.07
|
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$46.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.07
|
| Rate for Payer: BCBS Complete |
$37.58
|
| Rate for Payer: Cash Price |
$75.17
|
| Rate for Payer: Cofinity Advantage |
$65.77
|
| Rate for Payer: Cofinity Commercial |
$80.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.17
|
| Rate for Payer: Healthscope Commercial |
$84.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.47
|
| Rate for Payer: PHP Commercial |
$79.87
|
| Rate for Payer: Priority Health SBD |
$59.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.07
|
| Rate for Payer: UHC Core |
$48.95
|
| Rate for Payer: UHC Exchange |
$36.93
|
| Rate for Payer: UMR Bronson Commercial |
$34.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.47
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$667.73
|
|
|
Service Code
|
NDC 63323088601
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$600.96 |
| Rate for Payer: Aetna American Axle |
$434.02
|
| Rate for Payer: Aetna Commercial |
$567.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.02
|
| Rate for Payer: Cash Price |
$534.18
|
| Rate for Payer: Cofinity Advantage |
$467.41
|
| Rate for Payer: Cofinity Commercial |
$574.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.18
|
| Rate for Payer: Healthscope Commercial |
$600.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$467.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.80
|
| Rate for Payer: PHP Commercial |
$567.57
|
| Rate for Payer: Priority Health SBD |
$420.67
|
| Rate for Payer: UMR Bronson Commercial |
$293.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.80
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.01 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna American Axle |
$186.15
|
| Rate for Payer: Aetna Commercial |
$243.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.15
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Advantage |
$200.47
|
| Rate for Payer: Cofinity Commercial |
$246.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: PHP Commercial |
$243.42
|
| Rate for Payer: Priority Health SBD |
$180.42
|
| Rate for Payer: UMR Bronson Commercial |
$126.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$122.66
|
|
|
Service Code
|
NDC 00517730501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Advantage |
$85.86
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.13
|
| Rate for Payer: Healthscope Commercial |
$110.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$182.05
|
|
|
Service Code
|
NDC 00517731501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: Cash Price |
$145.64
|
| Rate for Payer: Cofinity Advantage |
$127.44
|
| Rate for Payer: Cofinity Commercial |
$156.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.64
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.54
|
| Rate for Payer: PHP Commercial |
$154.74
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.54
|
|
