|
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
|
$22.70
|
|
|
Service Code
|
NDC 51754500101
|
| 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
|
OP
|
$28.04
|
|
|
Service Code
|
NDC 72572074020
|
| 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
|
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
|
$23.81
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna American Axle |
$15.48
|
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.48
|
| Rate for Payer: Cash Price |
$19.05
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.24
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.48
|
| Rate for Payer: Priority Health SBD |
$15.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.86
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| 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
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$102.80
|
|
|
Service Code
|
NDC 63323008950
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.04 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: Aetna American Axle |
$66.82
|
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: Aetna Medicare |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.82
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$92.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.38
|
| Rate for Payer: PHP Commercial |
$87.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.82
|
| Rate for Payer: Priority Health SBD |
$64.76
|
| Rate for Payer: UMR Bronson Commercial |
$38.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.10
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| 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
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662530
|
| 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
|
$102.80
|
|
|
Service Code
|
NDC 63323008950
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.23 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: Aetna American Axle |
$66.82
|
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.82
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$92.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.38
|
| Rate for Payer: PHP Commercial |
$87.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.82
|
| Rate for Payer: Priority Health SBD |
$64.76
|
| Rate for Payer: UMR Bronson Commercial |
$45.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.10
|
|
|
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 FOR ORAL FEEDS
|
Facility
|
IP
|
$8.05
|
|
|
Service Code
|
NDC 09900000097
|
| Hospital Charge Code |
150947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna American Axle |
$5.23
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.23
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.84
|
| Rate for Payer: PHP Commercial |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health SBD |
$5.07
|
| Rate for Payer: UMR Bronson Commercial |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
SODIUM BICARBONATE 1 MEQ/ML FOR ORAL FEEDS
|
Facility
|
OP
|
$8.05
|
|
|
Service Code
|
NDC 09900000097
|
| Hospital Charge Code |
150947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna American Axle |
$5.23
|
| Rate for Payer: Aetna Commercial |
$6.84
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.23
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.84
|
| Rate for Payer: PHP Commercial |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health SBD |
$5.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 2485 MG-CITRIC ACID 1949 MG (PICOT) POWDER PACKET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 64613004562
|
| Hospital Charge Code |
301795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 64980052810
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 00536104710
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$78.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$98.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00904726161
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 00536104710
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 64980052810
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$95.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
SODIUM BICARBONATE (BULK) POWDER
|
Facility
|
IP
|
$59.67
|
|
|
Service Code
|
NDC 00395268594
|
| Hospital Charge Code |
7310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$53.70 |
| Rate for Payer: Aetna American Axle |
$38.79
|
| Rate for Payer: Aetna Commercial |
$50.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.79
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$41.77
|
| Rate for Payer: Cofinity Commercial |
$51.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.74
|
| Rate for Payer: Healthscope Commercial |
$53.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.72
|
| Rate for Payer: PHP Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.79
|
| Rate for Payer: Priority Health SBD |
$37.59
|
| Rate for Payer: UMR Bronson Commercial |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.75
|
|
|
SODIUM BICARBONATE (BULK) POWDER
|
Facility
|
OP
|
$59.67
|
|
|
Service Code
|
NDC 00395268594
|
| Hospital Charge Code |
7310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$53.70 |
| Rate for Payer: Aetna American Axle |
$38.79
|
| Rate for Payer: Aetna Commercial |
$50.72
|
| Rate for Payer: Aetna Medicare |
$29.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.79
|
| Rate for Payer: BCBS Complete |
$23.87
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$41.77
|
| Rate for Payer: Cofinity Commercial |
$51.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.74
|
| Rate for Payer: Healthscope Commercial |
$53.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.72
|
| Rate for Payer: PHP Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.79
|
| Rate for Payer: Priority Health SBD |
$37.59
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.75
|
|
