|
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
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity 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 |
$23.44
|
| 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 |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
NDC 00904632078
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity 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 |
$23.44
|
| 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 |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna American Axle |
$10.16
|
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.16
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.29
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.16
|
| Rate for Payer: Priority Health SBD |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.72
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna American Axle |
$22.35
|
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna Medicare |
$17.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.35
|
| Rate for Payer: BCBS Complete |
$13.76
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.35
|
| Rate for Payer: Priority Health SBD |
$21.67
|
| Rate for Payer: UMR Bronson Commercial |
$12.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna American Axle |
$20.32
|
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.32
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity 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 |
$23.44
|
| 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 |
$23.44
|
|
|
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 |
$23.44
|
| 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 |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$34.39
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna American Axle |
$22.35
|
| Rate for Payer: Aetna Commercial |
$29.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.35
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.51
|
| Rate for Payer: Healthscope Commercial |
$30.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.23
|
| Rate for Payer: PHP Commercial |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.35
|
| Rate for Payer: Priority Health SBD |
$21.67
|
| Rate for Payer: UMR Bronson Commercial |
$15.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.79
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna American Axle |
$10.16
|
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.16
|
| Rate for Payer: BCBS Complete |
$6.25
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$13.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.29
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.16
|
| Rate for Payer: Priority Health SBD |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.72
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: BCBS Complete |
$16.13
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.21
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.21
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$37.23
|
|
|
Service Code
|
NDC 01320020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Aetna American Axle |
$24.20
|
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.20
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$26.06
|
| Rate for Payer: Cofinity Commercial |
$32.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$33.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.65
|
| Rate for Payer: PHP Commercial |
$31.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.20
|
| Rate for Payer: Priority Health SBD |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.92
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
OP
|
$37.23
|
|
|
Service Code
|
NDC 01320020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Aetna American Axle |
$24.20
|
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.20
|
| Rate for Payer: BCBS Complete |
$14.89
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$26.06
|
| Rate for Payer: Cofinity Commercial |
$32.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$33.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.65
|
| Rate for Payer: PHP Commercial |
$31.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.20
|
| Rate for Payer: Priority Health SBD |
$23.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.92
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$672.04
|
|
|
Service Code
|
NDC 46287000601
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.70 |
| Max. Negotiated Rate |
$604.84 |
| Rate for Payer: Aetna American Axle |
$436.83
|
| Rate for Payer: Aetna Commercial |
$571.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.83
|
| Rate for Payer: Cash Price |
$537.63
|
| Rate for Payer: Cofinity Commercial |
$470.43
|
| Rate for Payer: Cofinity Commercial |
$577.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.63
|
| Rate for Payer: Healthscope Commercial |
$604.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.23
|
| Rate for Payer: PHP Commercial |
$571.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.83
|
| Rate for Payer: Priority Health SBD |
$423.39
|
| Rate for Payer: UMR Bronson Commercial |
$295.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.03
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna American Axle |
$53.97
|
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna Medicare |
$41.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: BCBS Complete |
$33.21
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$74.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.97
|
| Rate for Payer: Priority Health SBD |
$52.31
|
| Rate for Payer: UMR Bronson Commercial |
$30.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.27
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$74.73 |
| Rate for Payer: Aetna American Axle |
$53.97
|
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$74.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.97
|
| Rate for Payer: Priority Health SBD |
$52.31
|
| Rate for Payer: UMR Bronson Commercial |
$36.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.27
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$672.04
|
|
|
Service Code
|
NDC 46287000601
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.65 |
| Max. Negotiated Rate |
$604.84 |
| Rate for Payer: Cofinity Commercial |
$577.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.43
|
| Rate for Payer: Aetna American Axle |
$436.83
|
| Rate for Payer: Aetna Commercial |
$571.23
|
| Rate for Payer: Aetna Medicare |
$336.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.83
|
| Rate for Payer: BCBS Complete |
$268.82
|
| Rate for Payer: Cash Price |
$537.63
|
| Rate for Payer: Cofinity Commercial |
$470.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.63
|
| Rate for Payer: Healthscope Commercial |
$604.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.23
|
| Rate for Payer: PHP Commercial |
$571.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.83
|
| Rate for Payer: Priority Health SBD |
$423.39
|
| Rate for Payer: UMR Bronson Commercial |
$248.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.03
|
|
|
SODIUM POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA
|
Facility
|
OP
|
$370.74
|
|
|
Service Code
|
NDC 46287000604
|
| Hospital Charge Code |
179841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna American Axle |
$240.98
|
| Rate for Payer: Aetna Commercial |
$315.13
|
| Rate for Payer: Aetna Medicare |
$185.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.98
|
| Rate for Payer: BCBS Complete |
$148.30
|
| Rate for Payer: Cash Price |
$296.59
|
| Rate for Payer: Cofinity Commercial |
$259.52
|
| Rate for Payer: Cofinity Commercial |
$318.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.59
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.13
|
| Rate for Payer: PHP Commercial |
$315.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.98
|
| Rate for Payer: Priority Health SBD |
$233.57
|
| Rate for Payer: UMR Bronson Commercial |
$137.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.06
|
|
|
SODIUM POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA
|
Facility
|
IP
|
$370.74
|
|
|
Service Code
|
NDC 46287000604
|
| Hospital Charge Code |
179841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.13 |
| Max. Negotiated Rate |
$333.67 |
| Rate for Payer: Aetna American Axle |
$240.98
|
| Rate for Payer: Aetna Commercial |
$315.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.98
|
| Rate for Payer: Cash Price |
$296.59
|
| Rate for Payer: Cofinity Commercial |
$259.52
|
| Rate for Payer: Cofinity Commercial |
$318.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.59
|
| Rate for Payer: Healthscope Commercial |
$333.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.13
|
| Rate for Payer: PHP Commercial |
$315.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.98
|
| Rate for Payer: Priority Health SBD |
$233.57
|
| Rate for Payer: UMR Bronson Commercial |
$163.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.06
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
OP
|
$19.72
|
|
|
Service Code
|
NDC 00517312025
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM-POT-MAG-CAL-CHLOR-ACE-GLUCONATE 25 MEQ-40.6 MEQ-5 MEQ/20 ML IV
|
Facility
|
IP
|
$19.72
|
|
|
Service Code
|
NDC 00517312025
|
| Hospital Charge Code |
117109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.76
|
| Rate for Payer: PHP Commercial |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.79
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 67457016300
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.19 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$95.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457016300
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.28
|
|
|
Service Code
|
NDC 67457016302
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.28
|
|
|
Service Code
|
NDC 67457016302
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.19 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna American Axle |
$167.23
|
| Rate for Payer: Aetna Commercial |
$218.69
|
| Rate for Payer: Aetna Medicare |
$128.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.23
|
| Rate for Payer: BCBS Complete |
$102.91
|
| Rate for Payer: Cash Price |
$205.82
|
| Rate for Payer: Cofinity Commercial |
$180.10
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.82
|
| Rate for Payer: Healthscope Commercial |
$231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.69
|
| Rate for Payer: PHP Commercial |
$218.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.23
|
| Rate for Payer: Priority Health SBD |
$162.09
|
| Rate for Payer: UMR Bronson Commercial |
$95.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.96
|
|
