|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.14
|
| Rate for Payer: UHC Core |
$11.34
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.92
|
|
|
Service Code
|
NDC 00409329461
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Exchange |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 51754200404
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818315
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818325
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.14
|
| Rate for Payer: UHC Core |
$11.34
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
NDC 51754200404
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.31
|
| Rate for Payer: UHC Core |
$38.72
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.92
|
|
|
Service Code
|
NDC 00409329451
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.14
|
| Rate for Payer: UHC Core |
$11.34
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
NDC 51754200401
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.31
|
| Rate for Payer: UHC Core |
$38.72
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.32
|
| Rate for Payer: UHC Core |
$21.10
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.05
|
|
|
Service Code
|
NDC 51754200104
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Advantage |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.29
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818325
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.32
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna American Axle |
$21.26
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UMR Bronson Commercial |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.53
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna American Axle |
$21.26
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.26
|
| Rate for Payer: UHC Core |
$17.04
|
| Rate for Payer: UHC Exchange |
$12.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.53
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219014210
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219014202
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338066904
|
| 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 Advantage |
$33.49
|
| 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 |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| 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 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
NDC 65219014202
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.67
|
| Rate for Payer: UHC Core |
$47.83
|
| Rate for Payer: UHC Exchange |
$36.08
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
NDC 65219014210
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.67
|
| Rate for Payer: UHC Core |
$47.83
|
| Rate for Payer: UHC Exchange |
$36.08
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338066904
|
| Hospital Charge Code |
9799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| 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 |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 10 % ORAL LIQUID CUSTOM (BULK)
|
Facility
|
IP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
169415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Advantage |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.78
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$280.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
POTASSIUM CHLORIDE 10 % ORAL LIQUID CUSTOM (BULK)
|
Facility
|
OP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
169415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna American Axle |
$414.08
|
| Rate for Payer: Aetna Commercial |
$541.48
|
| Rate for Payer: Aetna Medicare |
$318.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.08
|
| Rate for Payer: BCBS Complete |
$254.82
|
| Rate for Payer: Cash Price |
$509.63
|
| Rate for Payer: Cofinity Advantage |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.63
|
| Rate for Payer: Healthscope Commercial |
$573.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$445.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$509.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.78
|
| Rate for Payer: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.08
|
| Rate for Payer: UHC Core |
$331.90
|
| Rate for Payer: UHC Exchange |
$250.36
|
| Rate for Payer: UMR Bronson Commercial |
$235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
