|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE FOR OG REPLACEMENT
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0704-34
|
| Hospital Charge Code |
300232
|
|
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 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0704-34
|
| Hospital Charge Code |
36046
|
|
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 20 MEQ/L IN 0.45 % SODIUM CHLORIDE ML/M2/HR
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0704-34
|
| Hospital Charge Code |
300897
|
|
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 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0803-04
|
| Hospital Charge Code |
9795
|
|
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 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS 0.5 MAINTENANCE
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0803-04
|
| Hospital Charge Code |
301333
|
|
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 20 MEQ/L IN D5W-0.9% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0803-04
|
| Hospital Charge Code |
300207
|
|
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 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0663-04
|
| Hospital Charge Code |
9800
|
|
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 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE 0.5 MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
300403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE 1.5 MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
180375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
NDC 0264-7635-00
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna American Axle |
$51.84
|
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.84
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$55.82
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.79
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.82
|
| Rate for Payer: Priority Health SBD |
$50.24
|
| Rate for Payer: UMR Bronson Commercial |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE ML/M2/HR
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
300705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L-LACTATED RINGERS-5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0811-04
|
| Hospital Charge Code |
16014
|
|
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 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.09
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna American Axle |
$11.88
|
| Rate for Payer: Aetna American Axle |
$52.16
|
| Rate for Payer: Aetna American Axle |
$13.60
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$68.21
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.16
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS Complete |
$32.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$72.22
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$68.21
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$50.56
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.74
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.69
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$361.56
|
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna American Axle |
$52.16
|
| Rate for Payer: Aetna American Axle |
$17.75
|
| Rate for Payer: Aetna American Axle |
$312.81
|
| Rate for Payer: Aetna American Axle |
$11.88
|
| Rate for Payer: Aetna American Axle |
$13.60
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$472.81
|
| Rate for Payer: Aetna Commercial |
$409.06
|
| Rate for Payer: Aetna Commercial |
$68.21
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Cash Price |
$21.85
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$336.88
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$478.38
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$389.38
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$413.88
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$24.58
|
| Rate for Payer: Healthscope Commercial |
$433.12
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$72.22
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$500.62
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.21
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: PHP Commercial |
$23.21
|
| Rate for Payer: PHP Commercial |
$68.21
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$472.81
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$409.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.38
|
| Rate for Payer: Priority Health SBD |
$17.21
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$350.44
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$50.56
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$303.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.28
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$211.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.02
|
| Rate for Payer: UMR Bronson Commercial |
$244.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: UMR Bronson Commercial |
$35.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.19
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$668.75
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
300444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.25 |
| Max. Negotiated Rate |
$601.88 |
| Rate for Payer: Aetna American Axle |
$434.69
|
| Rate for Payer: Aetna Commercial |
$568.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.69
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cofinity Commercial |
$468.12
|
| Rate for Payer: Cofinity Commercial |
$575.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.00
|
| Rate for Payer: Healthscope Commercial |
$601.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.44
|
| Rate for Payer: PHP Commercial |
$568.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.12
|
| Rate for Payer: Priority Health SBD |
$421.31
|
| Rate for Payer: UMR Bronson Commercial |
$294.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.56
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0675-04
|
| Hospital Charge Code |
9807
|
|
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 ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 66758-160-13
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna American Axle |
$218.60
|
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.60
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.86
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.41
|
| Rate for Payer: Priority Health SBD |
$211.87
|
| Rate for Payer: UMR Bronson Commercial |
$147.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$399.95
|
|
|
Service Code
|
NDC 0574-0275-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$359.96 |
| Rate for Payer: Aetna American Axle |
$259.97
|
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.97
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Commercial |
$279.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Healthscope Commercial |
$359.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.96
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.96
|
| Rate for Payer: Priority Health SBD |
$251.97
|
| Rate for Payer: UMR Bronson Commercial |
$175.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 0781-1526-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.63
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 0904-7216-61
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 66758-160-06
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.36
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
|
