|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50.29
|
|
|
Service Code
|
NDC 69784023020
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$45.26 |
| Rate for Payer: Aetna American Axle |
$32.69
|
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.69
|
| Rate for Payer: BCBS Complete |
$20.12
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$43.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.23
|
| Rate for Payer: Healthscope Commercial |
$45.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.75
|
| Rate for Payer: PHP Commercial |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.69
|
| Rate for Payer: Priority Health SBD |
$31.68
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
NDC 69784022910
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
NDC 00409329945
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 69784023110
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$54.07
|
|
|
Service Code
|
NDC 69784023010
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$48.66 |
| Rate for Payer: Aetna American Axle |
$35.15
|
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Aetna Medicare |
$27.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.15
|
| Rate for Payer: BCBS Complete |
$21.63
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cofinity Commercial |
$37.85
|
| Rate for Payer: Cofinity Commercial |
$46.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.96
|
| Rate for Payer: PHP Commercial |
$45.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.15
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$20.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$64.97
|
|
|
Service Code
|
NDC 09900001916
|
| Hospital Charge Code |
300441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$58.47 |
| Rate for Payer: Aetna American Axle |
$42.23
|
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Medicare |
$32.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.23
|
| Rate for Payer: BCBS Complete |
$25.99
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$55.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.22
|
| Rate for Payer: PHP Commercial |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.23
|
| Rate for Payer: Priority Health SBD |
$40.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.73
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$64.97
|
|
|
Service Code
|
NDC 09900001916
|
| Hospital Charge Code |
300441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$58.47 |
| Rate for Payer: Aetna American Axle |
$42.23
|
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.23
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$55.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.22
|
| Rate for Payer: PHP Commercial |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.23
|
| Rate for Payer: Priority Health SBD |
$40.93
|
| Rate for Payer: UMR Bronson Commercial |
$28.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.73
|
|
|
SODIUM ACETATE 2 MEQ/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 09900000589
|
| Hospital Charge Code |
168962
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna American Axle |
$19.50
|
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
SODIUM ACETATE 2 MEQ/ML ORAL FOR FEEDS
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 09900000589
|
| Hospital Charge Code |
168962
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna American Axle |
$19.50
|
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
SODIUM BENZOATE 10 %-SODIUM PHENYLACETATE 10 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
NDC 67457084450
|
| Hospital Charge Code |
40917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,810.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Aetna American Axle |
$8,450.00
|
| Rate for Payer: Aetna Commercial |
$11,050.00
|
| Rate for Payer: Aetna Medicare |
$6,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,450.00
|
| Rate for Payer: BCBS Complete |
$5,200.00
|
| Rate for Payer: Cash Price |
$10,400.00
|
| Rate for Payer: Cofinity Commercial |
$11,180.00
|
| Rate for Payer: Cofinity Commercial |
$9,100.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,400.00
|
| Rate for Payer: Healthscope Commercial |
$11,700.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,100.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,050.00
|
| Rate for Payer: PHP Commercial |
$11,050.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,450.00
|
| Rate for Payer: Priority Health SBD |
$8,190.00
|
| Rate for Payer: UMR Bronson Commercial |
$4,810.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,750.00
|
|
|
SODIUM BENZOATE 10 %-SODIUM PHENYLACETATE 10 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$118,717.82
|
|
|
Service Code
|
NDC 00187001050
|
| Hospital Charge Code |
40917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43,925.59 |
| Max. Negotiated Rate |
$106,846.04 |
| Rate for Payer: Aetna American Axle |
$77,166.58
|
| Rate for Payer: Aetna Commercial |
$100,910.15
|
| Rate for Payer: Aetna Medicare |
$59,358.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,166.58
|
| Rate for Payer: BCBS Complete |
$47,487.13
|
| Rate for Payer: Cash Price |
$94,974.26
|
| Rate for Payer: Cofinity Commercial |
$102,097.33
|
| Rate for Payer: Cofinity Commercial |
$83,102.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94,974.26
|
| Rate for Payer: Healthscope Commercial |
$106,846.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,102.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,038.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,910.15
|
| Rate for Payer: PHP Commercial |
$100,910.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,166.58
|
| Rate for Payer: Priority Health SBD |
$74,792.23
|
| Rate for Payer: UMR Bronson Commercial |
$43,925.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,038.36
|
|
|
SODIUM BENZOATE 10 %-SODIUM PHENYLACETATE 10 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
NDC 67457084450
|
| Hospital Charge Code |
40917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,720.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Aetna American Axle |
$8,450.00
|
| Rate for Payer: Aetna Commercial |
$11,050.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,450.00
|
| Rate for Payer: Cash Price |
$10,400.00
|
| Rate for Payer: Cofinity Commercial |
$11,180.00
|
| Rate for Payer: Cofinity Commercial |
$9,100.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,400.00
|
| Rate for Payer: Healthscope Commercial |
$11,700.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,100.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,050.00
|
| Rate for Payer: PHP Commercial |
$11,050.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,450.00
|
| Rate for Payer: Priority Health SBD |
$8,190.00
|
| Rate for Payer: UMR Bronson Commercial |
$5,720.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,750.00
|
|
|
SODIUM BENZOATE 10 %-SODIUM PHENYLACETATE 10 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$118,717.82
|
|
|
Service Code
|
NDC 00187001050
|
| Hospital Charge Code |
40917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52,235.84 |
| Max. Negotiated Rate |
$106,846.04 |
| Rate for Payer: Aetna American Axle |
$77,166.58
|
| Rate for Payer: Aetna Commercial |
$100,910.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,166.58
|
| Rate for Payer: Cash Price |
$94,974.26
|
| Rate for Payer: Cofinity Commercial |
$102,097.33
|
| Rate for Payer: Cofinity Commercial |
$83,102.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94,974.26
|
| Rate for Payer: Healthscope Commercial |
$106,846.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,102.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,038.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,910.15
|
| Rate for Payer: PHP Commercial |
$100,910.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,166.58
|
| Rate for Payer: Priority Health SBD |
$74,792.23
|
| Rate for Payer: UMR Bronson Commercial |
$52,235.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,038.36
|
|
|
SODIUM BENZOATE (BULK) POWDER
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 38779055108
|
| Hospital Charge Code |
7305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
SODIUM BENZOATE (BULK) POWDER
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 38779055108
|
| Hospital Charge Code |
7305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$146.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.70
|
|
|
Service Code
|
NDC 51754500104
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Aetna American Axle |
$14.76
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.76
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.30
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health SBD |
$14.30
|
| Rate for Payer: UMR Bronson Commercial |
$9.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.02
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.04
|
|
|
Service Code
|
NDC 72572074001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.23
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.03
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$15.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna American Axle |
$23.14
|
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UMR Bronson Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.04
|
|
|
Service Code
|
NDC 72572074001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$19.63
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.23
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.03
|
|
