|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$83.91
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$75.52 |
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: UMR Bronson Commercial |
$36.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$83.91
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$75.52 |
| Rate for Payer: Aetna American Axle |
$54.54
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCN Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$31.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.93
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 81033022015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna American Axle |
$5.16
|
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.16
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cofinity Advantage |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$7.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.96
|
| Rate for Payer: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$32.86
|
|
|
Service Code
|
NDC 71656002151
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$29.57 |
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Advantage |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.64
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.36
|
| Rate for Payer: UHC Core |
$17.12
|
| Rate for Payer: UHC Exchange |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
6432
|
|
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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Advantage |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$28.20
|
|
|
Service Code
|
NDC 00121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna American Axle |
$18.33
|
| Rate for Payer: Aetna Commercial |
$23.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.33
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Advantage |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.15
|
| Rate for Payer: PHP Commercial |
$23.97
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.15
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$43.41
|
|
|
Service Code
|
NDC 00904706260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna American Axle |
$28.22
|
| Rate for Payer: Aetna Commercial |
$36.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.22
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cofinity Advantage |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.73
|
| Rate for Payer: Healthscope Commercial |
$39.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.56
|
| Rate for Payer: PHP Commercial |
$36.90
|
| Rate for Payer: Priority Health SBD |
$27.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
NDC 00904746243
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.40
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.22
|
| Rate for Payer: UHC Core |
$11.39
|
| Rate for Payer: UHC Exchange |
$8.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$637.04
|
|
|
Service Code
|
NDC 00603154258
|
| Hospital Charge Code |
6432
|
|
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 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Advantage |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health SBD |
$12.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
NDC 00904746262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.40
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.22
|
| Rate for Payer: UHC Core |
$11.39
|
| Rate for Payer: UHC Exchange |
$8.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$22.76
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna American Axle |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.79
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cofinity Advantage |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: Priority Health SBD |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.79
|
| Rate for Payer: UHC Core |
$11.86
|
| Rate for Payer: UHC Exchange |
$8.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.87
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Advantage |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: Priority Health SBD |
$7.62
|
| Rate for Payer: UMR Bronson Commercial |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$39.41
|
|
|
Service Code
|
NDC 60687062814
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Advantage |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.56
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UMR Bronson Commercial |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 81033022051
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna American Axle |
$5.16
|
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.16
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cofinity Advantage |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$7.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.96
|
| Rate for Payer: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.16
|
| Rate for Payer: UHC Core |
$4.14
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$73.26
|
|
|
Service Code
|
NDC 66689004850
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$65.93 |
| Rate for Payer: Aetna American Axle |
$47.62
|
| Rate for Payer: Aetna Commercial |
$62.27
|
| Rate for Payer: Aetna Medicare |
$36.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.62
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: Cash Price |
$58.61
|
| Rate for Payer: Cofinity Advantage |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.61
|
| Rate for Payer: Healthscope Commercial |
$65.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.95
|
| Rate for Payer: PHP Commercial |
$62.27
|
| Rate for Payer: Priority Health SBD |
$46.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.62
|
| Rate for Payer: UHC Core |
$38.17
|
| Rate for Payer: UHC Exchange |
$28.79
|
| Rate for Payer: UMR Bronson Commercial |
$27.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$39.41
|
|
|
Service Code
|
NDC 60687062845
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Advantage |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.56
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UMR Bronson Commercial |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 00904746180
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Advantage |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$8.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.33
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.35
|
| Rate for Payer: UHC Core |
$5.09
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$103.26
|
|
|
Service Code
|
NDC 72888004113
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$92.93 |
| Rate for Payer: Aetna American Axle |
$67.12
|
| Rate for Payer: Aetna Commercial |
$87.77
|
| Rate for Payer: Aetna Medicare |
$51.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.12
|
| Rate for Payer: BCBS Complete |
$41.30
|
| Rate for Payer: Cash Price |
$82.61
|
| Rate for Payer: Cofinity Advantage |
$72.28
|
| Rate for Payer: Cofinity Commercial |
$88.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.61
|
| Rate for Payer: Healthscope Commercial |
$92.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.44
|
| Rate for Payer: PHP Commercial |
$87.77
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.12
|
| Rate for Payer: UHC Core |
$53.80
|
| Rate for Payer: UHC Exchange |
$40.58
|
| Rate for Payer: UMR Bronson Commercial |
$38.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$43.41
|
|
|
Service Code
|
NDC 00904706260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$39.07 |
| Rate for Payer: Aetna American Axle |
$28.22
|
| Rate for Payer: Aetna Commercial |
$36.90
|
| Rate for Payer: Aetna Medicare |
$21.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.22
|
| Rate for Payer: BCBS Complete |
$17.36
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cofinity Advantage |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.73
|
| Rate for Payer: Healthscope Commercial |
$39.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.56
|
| Rate for Payer: PHP Commercial |
$36.90
|
| Rate for Payer: Priority Health SBD |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.22
|
| Rate for Payer: UHC Core |
$22.62
|
| Rate for Payer: UHC Exchange |
$17.06
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$39.41
|
|
|
Service Code
|
NDC 60687062814
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna Medicare |
$19.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: BCBS Complete |
$15.76
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Advantage |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.56
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.62
|
| Rate for Payer: UHC Core |
$20.53
|
| Rate for Payer: UHC Exchange |
$15.49
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$22.76
|
|
|
Service Code
|
NDC 00904746188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna American Axle |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.79
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cofinity Advantage |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: Priority Health SBD |
$14.34
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$39.41
|
|
|
Service Code
|
NDC 60687062845
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna Medicare |
$19.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: BCBS Complete |
$15.76
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Advantage |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.56
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.62
|
| Rate for Payer: UHC Core |
$20.53
|
| Rate for Payer: UHC Exchange |
$15.49
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 81033022015
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna American Axle |
$5.16
|
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.16
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cofinity Advantage |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$7.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.96
|
| Rate for Payer: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.16
|
| Rate for Payer: UHC Core |
$4.14
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
