|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 00487900760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna American Axle |
$1.76
|
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 00487900760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna American Axle |
$1.76
|
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
NDC 50190014123
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna American Axle |
$1.84
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.84
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UMR Bronson Commercial |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.12
|
|
|
SODIUM CHLORIDE 7 % FOR NEBULIZATION
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 83490020760
|
| Hospital Charge Code |
82134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna American Axle |
$2.14
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: Priority Health SBD |
$2.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna American Axle |
$16.86
|
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
NDC 00904731680
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna American Axle |
$11.93
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 00904731688
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
NDC 00904731688
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 00904731680
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna American Axle |
$10.18
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.18
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna American Axle |
$11.93
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 71351001101
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.84
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.16 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$305.90
|
|
|
Service Code
|
NDC 71351001101
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna Medicare |
$152.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: BCBS Complete |
$122.36
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.84
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$113.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$305.90
|
|
|
Service Code
|
NDC 69543026810
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.84
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$134.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$330.24
|
|
|
Service Code
|
NDC 00486112501
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.19 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna Medicare |
$165.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: BCBS Complete |
$132.10
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$122.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$276.16 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.23 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna American Axle |
$154.99
|
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$166.92
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UMR Bronson Commercial |
$88.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$305.90
|
|
|
Service Code
|
NDC 69543026810
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna American Axle |
$198.84
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna Medicare |
$152.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: BCBS Complete |
$122.36
|
| Rate for Payer: Cash Price |
$244.72
|
| Rate for Payer: Cofinity Commercial |
$214.13
|
| Rate for Payer: Cofinity Commercial |
$263.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$275.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.84
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: UMR Bronson Commercial |
$113.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.42
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna American Axle |
$89.69
|
| Rate for Payer: Aetna American Axle |
$22.93
|
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.93
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$96.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.93
|
| Rate for Payer: Priority Health SBD |
$86.93
|
| Rate for Payer: Priority Health SBD |
$22.22
|
| Rate for Payer: UMR Bronson Commercial |
$60.71
|
| Rate for Payer: UMR Bronson Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$137.98
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$124.18 |
| Rate for Payer: Aetna American Axle |
$89.69
|
| Rate for Payer: Aetna American Axle |
$22.93
|
| Rate for Payer: Aetna Commercial |
$29.98
|
| Rate for Payer: Aetna Commercial |
$117.28
|
| Rate for Payer: Aetna Medicare |
$68.99
|
| Rate for Payer: Aetna Medicare |
$17.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.93
|
| Rate for Payer: BCBS Complete |
$14.11
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$5.90
|
| Rate for Payer: BCN Commercial |
$5.90
|
| Rate for Payer: BCN Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$30.33
|
| Rate for Payer: Cofinity Commercial |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$96.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$31.74
|
| Rate for Payer: Healthscope Commercial |
$124.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.98
|
| Rate for Payer: PHP Commercial |
$117.28
|
| Rate for Payer: PHP Commercial |
$29.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.93
|
| Rate for Payer: Priority Health SBD |
$22.22
|
| Rate for Payer: Priority Health SBD |
$86.93
|
| Rate for Payer: UMR Bronson Commercial |
$51.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.48
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.23
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna American Axle |
$97.00
|
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: Aetna Medicare |
$74.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.00
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.00
|
| Rate for Payer: Priority Health SBD |
$94.01
|
| Rate for Payer: UMR Bronson Commercial |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
