|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.62
|
|
|
Service Code
|
NDC 71288020202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.62
|
|
|
Service Code
|
NDC 71288020202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.10
|
| Rate for Payer: Healthscope Commercial |
$42.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.48
|
| Rate for Payer: PHP Commercial |
$40.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$30.00
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.72
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.11
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Aetna American Axle |
$61.17
|
| Rate for Payer: Aetna Commercial |
$79.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.17
|
| Rate for Payer: Cash Price |
$75.29
|
| Rate for Payer: Cofinity Commercial |
$65.88
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.29
|
| Rate for Payer: Healthscope Commercial |
$84.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.99
|
| Rate for Payer: PHP Commercial |
$79.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.17
|
| Rate for Payer: Priority Health SBD |
$59.29
|
| Rate for Payer: UMR Bronson Commercial |
$41.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.58
|
|
|
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 Commercial |
$105.49
|
| Rate for Payer: Cofinity Commercial |
$85.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.86
|
| 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: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.73
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$122.66
|
|
|
Service Code
|
NDC 00517730525
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna Medicare |
$61.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: BCBS Complete |
$49.06
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Cofinity Commercial |
$85.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.86
|
| 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: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.73
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$45.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$111.71
|
|
|
Service Code
|
NDC 63323017005
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.15 |
| Max. Negotiated Rate |
$100.54 |
| Rate for Payer: Aetna American Axle |
$72.61
|
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.61
|
| Rate for Payer: Cash Price |
$89.37
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.37
|
| Rate for Payer: Healthscope Commercial |
$100.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.95
|
| Rate for Payer: PHP Commercial |
$94.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.61
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$49.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.11
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Aetna American Axle |
$61.17
|
| Rate for Payer: Aetna Commercial |
$79.99
|
| Rate for Payer: Aetna Medicare |
$47.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.17
|
| Rate for Payer: BCBS Complete |
$37.64
|
| Rate for Payer: Cash Price |
$75.29
|
| Rate for Payer: Cofinity Commercial |
$65.88
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.29
|
| Rate for Payer: Healthscope Commercial |
$84.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.99
|
| Rate for Payer: PHP Commercial |
$79.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.17
|
| Rate for Payer: Priority Health SBD |
$59.29
|
| Rate for Payer: UMR Bronson Commercial |
$34.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.58
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$123.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$315.16
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$283.64 |
| Rate for Payer: Aetna American Axle |
$204.85
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna Medicare |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.85
|
| Rate for Payer: BCBS Complete |
$126.06
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$271.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.85
|
| Rate for Payer: Priority Health SBD |
$198.55
|
| Rate for Payer: UMR Bronson Commercial |
$116.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.37
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$283.64 |
| Rate for Payer: Aetna American Axle |
$204.85
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.85
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$271.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.85
|
| Rate for Payer: Priority Health SBD |
$198.55
|
| Rate for Payer: UMR Bronson Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.37
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$315.16
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$283.64 |
| Rate for Payer: Aetna American Axle |
$204.85
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna Medicare |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.85
|
| Rate for Payer: BCBS Complete |
$126.06
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$271.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.85
|
| Rate for Payer: Priority Health SBD |
$198.55
|
| Rate for Payer: UMR Bronson Commercial |
$116.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.37
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$667.73
|
|
|
Service Code
|
NDC 63323088601
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$600.96 |
| Rate for Payer: Aetna American Axle |
$434.02
|
| Rate for Payer: Aetna Commercial |
$567.57
|
| Rate for Payer: Aetna Medicare |
$333.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.02
|
| Rate for Payer: BCBS Complete |
$267.09
|
| Rate for Payer: Cash Price |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$467.41
|
| Rate for Payer: Cofinity Commercial |
$574.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$467.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.18
|
| Rate for Payer: Healthscope Commercial |
$600.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$467.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.57
|
| Rate for Payer: PHP Commercial |
$567.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.02
|
| Rate for Payer: Priority Health SBD |
$420.67
|
| Rate for Payer: UMR Bronson Commercial |
$247.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.80
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$122.66
|
|
|
Service Code
|
NDC 00517730501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Cofinity Commercial |
$85.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.86
|
| 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: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.73
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$283.64 |
| Rate for Payer: Aetna American Axle |
$204.85
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.85
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$220.61
|
| Rate for Payer: Cofinity Commercial |
$271.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.85
|
| Rate for Payer: Priority Health SBD |
$198.55
|
| Rate for Payer: UMR Bronson Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.37
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$667.73
|
|
|
Service Code
|
NDC 63323088601
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$600.96 |
| Rate for Payer: Aetna American Axle |
$434.02
|
| Rate for Payer: Aetna Commercial |
$567.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.02
|
| Rate for Payer: Cash Price |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$467.41
|
| Rate for Payer: Cofinity Commercial |
$574.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$467.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.18
|
| Rate for Payer: Healthscope Commercial |
$600.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$467.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.57
|
| Rate for Payer: PHP Commercial |
$567.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.02
|
| Rate for Payer: Priority Health SBD |
$420.67
|
| Rate for Payer: UMR Bronson Commercial |
$293.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.80
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$122.66
|
|
|
Service Code
|
NDC 00517730501
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Aetna American Axle |
$79.73
|
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna Medicare |
$61.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: BCBS Complete |
$49.06
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Cofinity Commercial |
$85.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.86
|
| 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: PHP Commercial |
$104.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.73
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$45.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$123.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$111.71
|
|
|
Service Code
|
NDC 63323017005
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$100.54 |
| Rate for Payer: Aetna American Axle |
$72.61
|
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$55.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.61
|
| Rate for Payer: BCBS Complete |
$44.68
|
| Rate for Payer: Cash Price |
$89.37
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.37
|
| Rate for Payer: Healthscope Commercial |
$100.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.95
|
| Rate for Payer: PHP Commercial |
$94.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.61
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$41.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.78
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 09900001920
|
| Hospital Charge Code |
301290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$123.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 09900001920
|
| Hospital Charge Code |
301290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.43 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna American Axle |
$160.18
|
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$172.50
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health SBD |
$155.25
|
| Rate for Payer: UMR Bronson Commercial |
$108.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML ORAL FOR FEEDS
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 09900000095
|
| Hospital Charge Code |
150946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna American Axle |
$11.05
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: UMR Bronson Commercial |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML ORAL FOR FEEDS
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 09900000095
|
| Hospital Charge Code |
150946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna American Axle |
$11.05
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.05
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.45
|
| Rate for Payer: PHP Commercial |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.75
|
|
|
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 Commercial |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.88
|
| 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: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.32
|
| Rate for Payer: Priority Health SBD |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
|
