|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$182.05
|
|
|
Service Code
|
NDC 00517731525
|
| 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
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 00409739182
|
| 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
|
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
|
$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
|
$237.00
|
|
|
Service Code
|
NDC 63323088101
|
| 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
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| 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
|
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 (TPN COMPONENT)
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 09900001920
|
| Hospital Charge Code |
301290
|
|
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 (TPN COMPONENT)
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 09900001920
|
| Hospital Charge Code |
301290
|
|
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 ORAL FOR FEEDS
|
Facility
|
OP
|
$38.70
|
|
|
Service Code
|
NDC 09900000095
|
| Hospital Charge Code |
150946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna American Axle |
$25.16
|
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: Cash Price |
$30.96
|
| Rate for Payer: Cofinity Advantage |
$27.09
|
| Rate for Payer: Cofinity Commercial |
$33.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.96
|
| Rate for Payer: Healthscope Commercial |
$34.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.02
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health SBD |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.16
|
| Rate for Payer: UHC Core |
$20.16
|
| Rate for Payer: UHC Exchange |
$15.21
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.02
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$38.70
|
|
|
Service Code
|
NDC 09900000095
|
| Hospital Charge Code |
150946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna American Axle |
$25.16
|
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: Cash Price |
$30.96
|
| Rate for Payer: Cofinity Advantage |
$27.09
|
| Rate for Payer: Cofinity Commercial |
$33.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.96
|
| Rate for Payer: Healthscope Commercial |
$34.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.02
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health SBD |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.02
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna American Axle |
$22.35
|
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.35
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Advantage |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.79
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health SBD |
$21.67
|
| Rate for Payer: UMR Bronson Commercial |
$15.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.32
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00904632078
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.32
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna American Axle |
$10.16
|
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.16
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Advantage |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.72
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: Priority Health SBD |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.72
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna American Axle |
$10.16
|
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.16
|
| Rate for Payer: BCBS Complete |
$6.25
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Advantage |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.72
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: Priority Health SBD |
$9.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.16
|
| Rate for Payer: UHC Core |
$8.14
|
| Rate for Payer: UHC Exchange |
$6.14
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.72
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna American Axle |
$22.35
|
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$17.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.35
|
| Rate for Payer: BCBS Complete |
$13.76
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Advantage |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.79
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health SBD |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Exchange |
$13.52
|
| Rate for Payer: UMR Bronson Commercial |
$12.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00904632078
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.45
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: BCBS Complete |
$16.13
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.21
|
| Rate for Payer: UHC Core |
$21.01
|
| Rate for Payer: UHC Exchange |
$15.85
|
| Rate for Payer: UMR Bronson Commercial |
$14.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna American Axle |
$53.97
|
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Advantage |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$74.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.27
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health SBD |
$52.31
|
| Rate for Payer: UMR Bronson Commercial |
$36.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.27
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna American Axle |
$53.97
|
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna Medicare |
$41.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: BCBS Complete |
$33.21
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Advantage |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$74.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.27
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health SBD |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.97
|
| Rate for Payer: UHC Core |
$43.26
|
| Rate for Payer: UHC Exchange |
$32.63
|
| Rate for Payer: UMR Bronson Commercial |
$30.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.27
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP
|
Facility
|
OP
|
$76.59
|
|
|
Service Code
|
NDC 62559035660
|
| Hospital Charge Code |
179838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Medicare |
$38.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.78
|
| Rate for Payer: UHC Core |
$39.90
|
| Rate for Payer: UHC Exchange |
$30.10
|
| Rate for Payer: UMR Bronson Commercial |
$28.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
NDC 62559035660
|
| Hospital Charge Code |
179838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
