|
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 Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.49
|
| 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: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| 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
|
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 Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.49
|
| 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: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| 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 % 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 Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| 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: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| Rate for Payer: UMR Bronson Commercial |
$235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.78
|
|
|
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 Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| 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: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| 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/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 66689004799
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.41
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.77
|
|
|
Service Code
|
NDC 63739072450
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna American Axle |
$6.35
|
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.35
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| 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: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 63739072450
|
| 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 Commercial |
$6.84
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.84
|
| 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: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| 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
|
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 Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.38
|
| 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: PHP Commercial |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| 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
|
$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 Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| 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: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| 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
|
$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 Commercial |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.39
|
| 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: PHP Commercial |
$36.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.22
|
| 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
|
$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 Commercial |
$445.93
|
| Rate for Payer: Cofinity Commercial |
$547.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$445.93
|
| 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: PHP Commercial |
$541.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.08
|
| Rate for Payer: Priority Health SBD |
$401.34
|
| 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
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 00904746262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 66689004750
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00904706180
|
| 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 Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.47
|
| 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: PHP Commercial |
$10.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| 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
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 66689004750
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
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 Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| 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: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.16
|
| 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
|
$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 Commercial |
$51.28
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.28
|
| 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: Multiplan/Beech St/PHCS Commercial |
$62.27
|
| Rate for Payer: PHP Commercial |
$62.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.62
|
| Rate for Payer: Priority Health SBD |
$46.15
|
| 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
|
OP
|
$40.63
|
|
|
Service Code
|
NDC 00904706262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Aetna American Axle |
$26.41
|
| Rate for Payer: Aetna Commercial |
$34.54
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.41
|
| Rate for Payer: BCBS Complete |
$16.25
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cofinity Commercial |
$28.44
|
| Rate for Payer: Cofinity Commercial |
$34.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.50
|
| Rate for Payer: Healthscope Commercial |
$36.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.54
|
| Rate for Payer: PHP Commercial |
$34.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.41
|
| Rate for Payer: Priority Health SBD |
$25.60
|
| Rate for Payer: UMR Bronson Commercial |
$15.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.47
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687034150
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$33.73
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.32
|
| Rate for Payer: Priority Health SBD |
$30.35
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 66689004799
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.41
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$7.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$38.19
|
|
|
Service Code
|
NDC 60687034145
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$34.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.46
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.82
|
| Rate for Payer: Priority Health SBD |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$14.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$47.73
|
|
|
Service Code
|
NDC 60687062845
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.41
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: PHP Commercial |
$40.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.07
|
| Rate for Payer: UMR Bronson Commercial |
$21.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.80
|
|
|
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 Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| 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: PHP Commercial |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.16
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
