|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$286.90
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.49
|
| Rate for Payer: Aetna Commercial |
$243.87
|
| Rate for Payer: Aetna Medicare |
$143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.49
|
| Rate for Payer: BCBS Complete |
$114.76
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Advantage |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: PHP Commercial |
$243.87
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.49
|
| Rate for Payer: UHC Core |
$149.47
|
| Rate for Payer: UHC Exchange |
$112.75
|
| Rate for Payer: UMR Bronson Commercial |
$106.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2,561.50
|
|
|
Service Code
|
NDC 00832532310
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$947.75 |
| Max. Negotiated Rate |
$2,305.35 |
| Rate for Payer: Aetna American Axle |
$1,664.97
|
| Rate for Payer: Aetna Commercial |
$2,177.28
|
| Rate for Payer: Aetna Medicare |
$1,280.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.97
|
| Rate for Payer: BCBS Complete |
$1,024.60
|
| Rate for Payer: Cash Price |
$2,049.20
|
| Rate for Payer: Cofinity Advantage |
$1,793.05
|
| Rate for Payer: Cofinity Commercial |
$2,202.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,049.20
|
| Rate for Payer: Healthscope Commercial |
$2,305.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,793.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,921.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,049.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,177.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,921.12
|
| Rate for Payer: PHP Commercial |
$2,177.28
|
| Rate for Payer: Priority Health SBD |
$1,613.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,664.97
|
| Rate for Payer: UHC Core |
$1,334.54
|
| Rate for Payer: UHC Exchange |
$1,006.67
|
| Rate for Payer: UMR Bronson Commercial |
$947.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,921.12
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 24979023001
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.03
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.03
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Advantage |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health SBD |
$162.85
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 72888007501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna American Axle |
$184.83
|
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.83
|
| Rate for Payer: UHC Core |
$148.15
|
| Rate for Payer: UHC Exchange |
$111.75
|
| Rate for Payer: UMR Bronson Commercial |
$105.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$399.95
|
|
|
Service Code
|
NDC 00574027501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$359.95 |
| Rate for Payer: Aetna American Axle |
$259.97
|
| Rate for Payer: Aetna Commercial |
$339.96
|
| Rate for Payer: Aetna Medicare |
$199.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.97
|
| Rate for Payer: BCBS Complete |
$159.98
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Cofinity Advantage |
$279.96
|
| Rate for Payer: Cofinity Commercial |
$343.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.96
|
| Rate for Payer: Healthscope Commercial |
$359.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.96
|
| Rate for Payer: PHP Commercial |
$339.96
|
| Rate for Payer: Priority Health SBD |
$251.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.97
|
| Rate for Payer: UHC Core |
$208.37
|
| Rate for Payer: UHC Exchange |
$157.18
|
| Rate for Payer: UMR Bronson Commercial |
$147.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.96
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,356.10
|
|
|
Service Code
|
NDC 60258000316
|
| 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 |
$881.47
|
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.47
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Advantage |
$949.27
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| 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 Commercial |
$1,152.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.08
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| 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
|
$700.28
|
|
|
Service Code
|
NDC 00121067616
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.12 |
| Max. Negotiated Rate |
$630.25 |
| Rate for Payer: Aetna American Axle |
$455.18
|
| Rate for Payer: Aetna Commercial |
$595.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.18
|
| Rate for Payer: Cash Price |
$560.22
|
| Rate for Payer: Cofinity Advantage |
$490.20
|
| Rate for Payer: Cofinity Commercial |
$602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.22
|
| Rate for Payer: Healthscope Commercial |
$630.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.21
|
| Rate for Payer: PHP Commercial |
$595.24
|
| Rate for Payer: Priority Health SBD |
$441.18
|
| Rate for Payer: UMR Bronson Commercial |
$308.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.21
|
|
|
POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,356.10
|
|
|
Service Code
|
NDC 60258000316
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna American Axle |
$881.47
|
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna Medicare |
$678.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.47
|
| Rate for Payer: BCBS Complete |
$542.44
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Advantage |
$949.27
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| 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: MI Amish Medical Board Commercial |
$1,084.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,152.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.08
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: Priority Health SBD |
$854.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$881.47
|
| Rate for Payer: UHC Core |
$706.53
|
| Rate for Payer: UHC Exchange |
$532.95
|
| Rate for Payer: UMR Bronson Commercial |
$501.76
|
| 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
|
OP
|
$700.28
|
|
|
Service Code
|
NDC 00121067616
|
| Hospital Charge Code |
22646
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.10 |
| Max. Negotiated Rate |
$630.25 |
| Rate for Payer: Aetna American Axle |
$455.18
|
| Rate for Payer: Aetna Commercial |
$595.24
|
| Rate for Payer: Aetna Medicare |
$350.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.18
|
| Rate for Payer: BCBS Complete |
$280.11
|
| Rate for Payer: Cash Price |
$560.22
|
| Rate for Payer: Cofinity Advantage |
$490.20
|
| Rate for Payer: Cofinity Commercial |
$602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.22
|
| Rate for Payer: Healthscope Commercial |
$630.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$560.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.21
|
| Rate for Payer: PHP Commercial |
$595.24
|
| Rate for Payer: Priority Health SBD |
$441.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.18
|
| Rate for Payer: UHC Core |
$364.85
|
| Rate for Payer: UHC Exchange |
$275.21
|
| Rate for Payer: UMR Bronson Commercial |
$259.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.21
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$291.65
|
|
|
Service Code
|
NDC 42543040701
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.91 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna American Axle |
$189.57
|
| Rate for Payer: Aetna Commercial |
$247.90
|
| Rate for Payer: Aetna Medicare |
$145.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.57
|
| Rate for Payer: BCBS Complete |
$116.66
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Advantage |
$204.16
|
| Rate for Payer: Cofinity Commercial |
$250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.74
|
| Rate for Payer: PHP Commercial |
$247.90
|
| Rate for Payer: Priority Health SBD |
$183.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.57
|
| Rate for Payer: UHC Core |
$151.95
|
| Rate for Payer: UHC Exchange |
$114.62
|
| Rate for Payer: UMR Bronson Commercial |
$107.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.74
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
NDC 00245007111
|
| 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 Advantage |
$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 Commercial |
$536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PHP Commercial |
$536.93
|
| 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 CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$631.68
|
|
|
Service Code
|
NDC 00245007111
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.72 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna Medicare |
$315.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: BCBS Complete |
$252.67
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$505.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.59
|
| Rate for Payer: UHC Core |
$329.11
|
| Rate for Payer: UHC Exchange |
$248.25
|
| Rate for Payer: UMR Bronson Commercial |
$233.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$220.40
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna American Axle |
$143.26
|
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Advantage |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.30
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health SBD |
$138.85
|
| Rate for Payer: UMR Bronson Commercial |
$96.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$220.40
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna American Axle |
$143.26
|
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna Medicare |
$110.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: BCBS Complete |
$88.16
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Advantage |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.30
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health SBD |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.26
|
| Rate for Payer: UHC Core |
$114.83
|
| Rate for Payer: UHC Exchange |
$86.62
|
| Rate for Payer: UMR Bronson Commercial |
$81.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$291.65
|
|
|
Service Code
|
NDC 42543040701
|
| Hospital Charge Code |
11083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna American Axle |
$189.57
|
| Rate for Payer: Aetna Commercial |
$247.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.57
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Advantage |
$204.16
|
| Rate for Payer: Cofinity Commercial |
$250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.74
|
| Rate for Payer: PHP Commercial |
$247.90
|
| Rate for Payer: Priority Health SBD |
$183.74
|
| Rate for Payer: UMR Bronson Commercial |
$128.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.74
|
|
|
POTASSIUM HYDROXIDE (BULK) PELLET
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
NDC 62991303901
|
| 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 Advantage |
$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 Commercial |
$295.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.00
|
| Rate for Payer: PHP Commercial |
$295.80
|
| 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 HYDROXIDE (BULK) PELLET
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
NDC 62991303901
|
| Hospital Charge Code |
27652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$278.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.00
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$181.31
|
| Rate for Payer: UHC Exchange |
$136.76
|
| Rate for Payer: UMR Bronson Commercial |
$128.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,007.06
|
|
|
Service Code
|
NDC 75834028030
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$443.11 |
| Max. Negotiated Rate |
$906.35 |
| Rate for Payer: Aetna American Axle |
$654.59
|
| Rate for Payer: Aetna Commercial |
$856.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.59
|
| Rate for Payer: Cash Price |
$805.65
|
| Rate for Payer: Cofinity Advantage |
$704.94
|
| Rate for Payer: Cofinity Commercial |
$866.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.65
|
| Rate for Payer: Healthscope Commercial |
$906.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$704.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$755.29
|
| Rate for Payer: PHP Commercial |
$856.00
|
| Rate for Payer: Priority Health SBD |
$634.45
|
| Rate for Payer: UMR Bronson Commercial |
$443.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.29
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,047.80
|
|
|
Service Code
|
NDC 71740011230
|
| 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 Advantage |
$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 Commercial |
$890.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.85
|
| Rate for Payer: PHP Commercial |
$890.63
|
| 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 IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,047.80
|
|
|
Service Code
|
NDC 71740011230
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.69 |
| Max. Negotiated Rate |
$943.02 |
| Rate for Payer: Aetna American Axle |
$681.07
|
| Rate for Payer: Aetna Commercial |
$890.63
|
| Rate for Payer: Aetna Medicare |
$523.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.07
|
| Rate for Payer: BCBS Complete |
$419.12
|
| Rate for Payer: Cash Price |
$838.24
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$838.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.85
|
| Rate for Payer: PHP Commercial |
$890.63
|
| Rate for Payer: Priority Health SBD |
$660.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.07
|
| Rate for Payer: UHC Core |
$545.90
|
| Rate for Payer: UHC Exchange |
$411.79
|
| Rate for Payer: UMR Bronson Commercial |
$387.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.85
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 09900000984
|
| 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 Advantage |
$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 Commercial |
$0.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.32
|
| Rate for Payer: PHP Commercial |
$0.36
|
| 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
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 09900000984
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.36
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$0.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.32
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.27
|
| Rate for Payer: UHC Core |
$0.22
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.32
|
|
|
POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,007.06
|
|
|
Service Code
|
NDC 75834028030
|
| Hospital Charge Code |
6445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$372.61 |
| Max. Negotiated Rate |
$906.35 |
| Rate for Payer: Aetna American Axle |
$654.59
|
| Rate for Payer: Aetna Commercial |
$856.00
|
| Rate for Payer: Aetna Medicare |
$503.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.59
|
| Rate for Payer: BCBS Complete |
$402.82
|
| Rate for Payer: Cash Price |
$805.65
|
| Rate for Payer: Cofinity Advantage |
$704.94
|
| Rate for Payer: Cofinity Commercial |
$866.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.65
|
| Rate for Payer: Healthscope Commercial |
$906.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$704.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$805.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$755.29
|
| Rate for Payer: PHP Commercial |
$856.00
|
| Rate for Payer: Priority Health SBD |
$634.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.59
|
| Rate for Payer: UHC Core |
$524.68
|
| Rate for Payer: UHC Exchange |
$395.77
|
| Rate for Payer: UMR Bronson Commercial |
$372.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.29
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.68 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna American Axle |
$280.21
|
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Advantage |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.32
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UMR Bronson Commercial |
$189.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.32
|
|
