|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-466-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna American Axle |
$1.58
|
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687-466-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$218.02 |
| Rate for Payer: Aetna American Axle |
$157.46
|
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$169.58
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.91
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.58
|
| Rate for Payer: Priority Health SBD |
$152.62
|
| Rate for Payer: UMR Bronson Commercial |
$106.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.69
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 0074-7804-13
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 0574-0275-00
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 0574-0275-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.20
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$311.60
|
|
|
Service Code
|
NDC 0245-5316-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna American Axle |
$202.54
|
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.54
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.86
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.12
|
| Rate for Payer: Priority Health SBD |
$196.31
|
| Rate for Payer: UMR Bronson Commercial |
$137.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.70
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 0245-5316-89
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 0832-5323-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,356.10
|
|
|
Service Code
|
NDC 6025800316
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna American Axle |
$881.46
|
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.46
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| Rate for Payer: Cofinity Commercial |
$949.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$1,220.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,152.68
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.27
|
| Rate for Payer: Priority Health SBD |
$854.34
|
| Rate for Payer: UMR Bronson Commercial |
$596.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.08
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$511.32
|
|
|
Service Code
|
NDC 121067616
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.98 |
| Max. Negotiated Rate |
$460.19 |
| Rate for Payer: Aetna American Axle |
$332.36
|
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.36
|
| Rate for Payer: Cash Price |
$409.06
|
| Rate for Payer: Cofinity Commercial |
$357.92
|
| Rate for Payer: Cofinity Commercial |
$439.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.06
|
| Rate for Payer: Healthscope Commercial |
$460.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.62
|
| Rate for Payer: PHP Commercial |
$434.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.92
|
| Rate for Payer: Priority Health SBD |
$322.13
|
| Rate for Payer: UMR Bronson Commercial |
$224.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.49
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 42543-407-01
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.60
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
NDC 0245-0071-11
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.93
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.18
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UMR Bronson Commercial |
$277.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
POTASSIUM HYDROXIDE (BULK) PELLET
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
NDC 6299130391
|
| Hospital Charge Code |
27652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.80
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$153.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 9900-0009-84
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.29
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.32
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$973.67
|
|
|
Service Code
|
NDC 75834-280-30
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.41 |
| Max. Negotiated Rate |
$876.30 |
| Rate for Payer: Aetna American Axle |
$632.89
|
| Rate for Payer: Aetna Commercial |
$827.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.89
|
| Rate for Payer: Cash Price |
$778.94
|
| Rate for Payer: Cofinity Commercial |
$681.57
|
| Rate for Payer: Cofinity Commercial |
$837.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$778.94
|
| Rate for Payer: Healthscope Commercial |
$876.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$681.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$827.62
|
| Rate for Payer: PHP Commercial |
$827.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.57
|
| Rate for Payer: Priority Health SBD |
$613.41
|
| Rate for Payer: UMR Bronson Commercial |
$428.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.25
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,047.80
|
|
|
Service Code
|
NDC 71740-112-30
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.03 |
| Max. Negotiated Rate |
$943.02 |
| Rate for Payer: Aetna American Axle |
$681.07
|
| Rate for Payer: Aetna Commercial |
$890.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.07
|
| Rate for Payer: Cash Price |
$838.24
|
| Rate for Payer: Cofinity Commercial |
$733.46
|
| Rate for Payer: Cofinity Commercial |
$901.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.24
|
| Rate for Payer: Healthscope Commercial |
$943.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$890.63
|
| Rate for Payer: PHP Commercial |
$890.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.46
|
| Rate for Payer: Priority Health SBD |
$660.11
|
| Rate for Payer: UMR Bronson Commercial |
$461.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.85
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$399.12
|
|
|
Service Code
|
NDC 46287-024-15
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$175.61 |
| Max. Negotiated Rate |
$359.21 |
| Rate for Payer: Aetna American Axle |
$259.43
|
| Rate for Payer: Aetna Commercial |
$339.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.43
|
| Rate for Payer: Cash Price |
$319.30
|
| Rate for Payer: Cofinity Commercial |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$343.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.30
|
| Rate for Payer: Healthscope Commercial |
$359.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.25
|
| Rate for Payer: PHP Commercial |
$339.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.38
|
| Rate for Payer: Priority Health SBD |
$251.45
|
| Rate for Payer: UMR Bronson Commercial |
$175.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.34
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$399.12
|
|
|
Service Code
|
NDC 46287-024-10
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$175.61 |
| Max. Negotiated Rate |
$359.21 |
| Rate for Payer: Aetna American Axle |
$259.43
|
| Rate for Payer: Aetna Commercial |
$339.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.43
|
| Rate for Payer: Cash Price |
$319.30
|
| Rate for Payer: Cofinity Commercial |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$343.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.30
|
| Rate for Payer: Healthscope Commercial |
$359.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.25
|
| Rate for Payer: PHP Commercial |
$339.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.38
|
| Rate for Payer: Priority Health SBD |
$251.45
|
| Rate for Payer: UMR Bronson Commercial |
$175.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.34
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78.33
|
|
|
Service Code
|
NDC 65219-052-09
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.47 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna American Axle |
$50.91
|
| Rate for Payer: Aetna Commercial |
$66.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.91
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$54.83
|
| Rate for Payer: Cofinity Commercial |
$67.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.58
|
| Rate for Payer: PHP Commercial |
$66.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.83
|
| Rate for Payer: Priority Health SBD |
$49.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.75
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219-056-09
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$334.31 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna American Axle |
$493.87
|
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.86
|
| Rate for Payer: Priority Health SBD |
$478.67
|
| Rate for Payer: UMR Bronson Commercial |
$334.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.85
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$77.78
|
|
|
Service Code
|
NDC 63323-086-05
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna American Axle |
$50.56
|
| Rate for Payer: Aetna Commercial |
$66.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.56
|
| Rate for Payer: Cash Price |
$62.22
|
| Rate for Payer: Cofinity Commercial |
$54.45
|
| Rate for Payer: Cofinity Commercial |
$66.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.11
|
| Rate for Payer: PHP Commercial |
$66.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.45
|
| Rate for Payer: Priority Health SBD |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.34
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219-056-29
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$334.31 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna American Axle |
$493.87
|
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.86
|
| Rate for Payer: Priority Health SBD |
$478.67
|
| Rate for Payer: UMR Bronson Commercial |
$334.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.85
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78.33
|
|
|
Service Code
|
NDC 65219-052-29
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.47 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna American Axle |
$50.91
|
| Rate for Payer: Aetna Commercial |
$66.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.91
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$54.83
|
| Rate for Payer: Cofinity Commercial |
$67.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.58
|
| Rate for Payer: PHP Commercial |
$66.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.83
|
| Rate for Payer: Priority Health SBD |
$49.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.75
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323-086-15
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.68 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna American Axle |
$266.92
|
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.45
|
| Rate for Payer: Priority Health SBD |
$258.70
|
| Rate for Payer: UMR Bronson Commercial |
$180.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.98
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$183.79
|
|
|
Service Code
|
NDC 0409-7295-11
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$165.41 |
| Rate for Payer: Aetna American Axle |
$119.46
|
| Rate for Payer: Aetna Commercial |
$156.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.46
|
| Rate for Payer: Cash Price |
$147.03
|
| Rate for Payer: Cofinity Commercial |
$128.65
|
| Rate for Payer: Cofinity Commercial |
$158.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.03
|
| Rate for Payer: Healthscope Commercial |
$165.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.22
|
| Rate for Payer: PHP Commercial |
$156.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.65
|
| Rate for Payer: Priority Health SBD |
$115.79
|
| Rate for Payer: UMR Bronson Commercial |
$80.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.84
|
|
