|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$31.15
|
|
|
Service Code
|
NDC 9900-0019-17
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.48
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.80
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0669-04
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 10 % ORAL LIQUID CUSTOM (BULK)
|
Facility
|
IP
|
$110.26
|
|
|
Service Code
|
NDC 0603-1542-58
|
| Hospital Charge Code |
169415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Aetna American Axle |
$71.67
|
| Rate for Payer: Aetna Commercial |
$93.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.67
|
| Rate for Payer: Cash Price |
$88.21
|
| Rate for Payer: Cofinity Commercial |
$77.18
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.21
|
| Rate for Payer: Healthscope Commercial |
$99.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.72
|
| Rate for Payer: PHP Commercial |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.18
|
| Rate for Payer: Priority Health SBD |
$69.46
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.70
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 60687-341-45
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.46
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.73
|
| Rate for Payer: Priority Health SBD |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689-047-01
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.46
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687-341-71
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.73
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$110.26
|
|
|
Service Code
|
NDC 0603-1542-58
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Aetna American Axle |
$71.67
|
| Rate for Payer: Aetna Commercial |
$93.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.67
|
| Rate for Payer: Cash Price |
$88.21
|
| Rate for Payer: Cofinity Commercial |
$77.18
|
| Rate for Payer: Cofinity Commercial |
$94.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.21
|
| Rate for Payer: Healthscope Commercial |
$99.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.72
|
| Rate for Payer: PHP Commercial |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.18
|
| Rate for Payer: Priority Health SBD |
$69.46
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.70
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
NDC 60687-628-14
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna American Axle |
$29.51
|
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: UMR Bronson Commercial |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.05
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 81033-220-15
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.24
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 66689-048-01
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.05
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.27
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.86
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$72.93
|
|
|
Service Code
|
NDC 66689-048-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$65.64 |
| Rate for Payer: Aetna American Axle |
$47.40
|
| Rate for Payer: Aetna Commercial |
$61.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.40
|
| Rate for Payer: Cash Price |
$58.34
|
| Rate for Payer: Cofinity Commercial |
$51.05
|
| Rate for Payer: Cofinity Commercial |
$62.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.34
|
| Rate for Payer: Healthscope Commercial |
$65.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.99
|
| Rate for Payer: PHP Commercial |
$61.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
| Rate for Payer: Priority Health SBD |
$45.95
|
| Rate for Payer: UMR Bronson Commercial |
$32.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.70
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
NDC 60687-628-45
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna American Axle |
$29.51
|
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: UMR Bronson Commercial |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.05
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 66689-047-99
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687-341-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.73
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 66689-047-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687-341-44
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.73
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 0904-7061-80
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.24
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
NDC 60687-341-72
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna American Axle |
$40.62
|
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.62
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$43.75
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$56.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.12
|
| Rate for Payer: PHP Commercial |
$53.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.75
|
| Rate for Payer: Priority Health SBD |
$39.38
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0904-7061-88
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.09
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
NDC 0904-7062-62
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna American Axle |
$29.51
|
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: UMR Bronson Commercial |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.05
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689-047-30
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.46
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 81033-220-51
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.24
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
NDC 0904-7062-60
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna Commercial |
$36.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Cash Price |
$34.54
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.54
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.70
|
| Rate for Payer: PHP Commercial |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.23
|
| Rate for Payer: Priority Health SBD |
$27.20
|
| Rate for Payer: UMR Bronson Commercial |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.38
|
|
