|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 81033022051
|
| 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
|
IP
|
$38.19
|
|
|
Service Code
|
NDC 60687034145
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Aetna American Axle |
$24.82
|
| Rate for Payer: Aetna Commercial |
$32.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.82
|
| 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 |
$16.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.64
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$89.03
|
|
|
Service Code
|
NDC 66689004801
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$80.13 |
| Rate for Payer: Aetna American Axle |
$57.87
|
| Rate for Payer: Aetna Commercial |
$75.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.87
|
| Rate for Payer: Cash Price |
$71.22
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Cofinity Commercial |
$76.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.22
|
| Rate for Payer: Healthscope Commercial |
$80.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.68
|
| Rate for Payer: PHP Commercial |
$75.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.87
|
| Rate for Payer: Priority Health SBD |
$56.09
|
| Rate for Payer: UMR Bronson Commercial |
$39.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.77
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 00904746262
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| 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 |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$48.18
|
|
|
Service Code
|
NDC 60687034171
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna American Axle |
$31.32
|
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.32
|
| Rate for Payer: BCBS Complete |
$19.27
|
| 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 |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.13
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$89.03
|
|
|
Service Code
|
NDC 66689004801
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$80.13 |
| Rate for Payer: Aetna American Axle |
$57.87
|
| Rate for Payer: Aetna Commercial |
$75.68
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.87
|
| Rate for Payer: BCBS Complete |
$35.61
|
| Rate for Payer: Cash Price |
$71.22
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Cofinity Commercial |
$76.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.22
|
| Rate for Payer: Healthscope Commercial |
$80.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.68
|
| Rate for Payer: PHP Commercial |
$75.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.87
|
| Rate for Payer: Priority Health SBD |
$56.09
|
| Rate for Payer: UMR Bronson Commercial |
$32.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.77
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 00121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 00121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 00121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$47.51
|
|
|
Service Code
|
NDC 00904746260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$42.76 |
| Rate for Payer: Aetna American Axle |
$30.88
|
| Rate for Payer: Aetna Commercial |
$40.38
|
| Rate for Payer: Aetna Medicare |
$23.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.88
|
| Rate for Payer: BCBS Complete |
$19.00
|
| Rate for Payer: Cash Price |
$38.01
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.01
|
| Rate for Payer: Healthscope Commercial |
$42.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.38
|
| Rate for Payer: PHP Commercial |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.88
|
| Rate for Payer: Priority Health SBD |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.63
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
NDC 00904746180
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
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 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
|
$13.27
|
|
|
Service Code
|
NDC 00904746180
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna American Axle |
$8.63
|
| Rate for Payer: Aetna Commercial |
$11.28
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.63
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.28
|
| Rate for Payer: PHP Commercial |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health SBD |
$8.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: BCBS Complete |
$8.22
|
| 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 |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$35.08
|
|
|
Service Code
|
NDC 71656002130
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna American Axle |
$22.80
|
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.80
|
| Rate for Payer: Cash Price |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.06
|
| Rate for Payer: Healthscope Commercial |
$31.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.82
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.80
|
| Rate for Payer: Priority Health SBD |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00904706180
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.87
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: BCBS Complete |
$4.84
|
| 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 |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$35.08
|
|
|
Service Code
|
NDC 71656002151
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna American Axle |
$22.80
|
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.80
|
| Rate for Payer: Cash Price |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.06
|
| Rate for Payer: Healthscope Commercial |
$31.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.82
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.80
|
| Rate for Payer: Priority Health SBD |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna American Axle |
$7.87
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: BCBS Complete |
$4.84
|
| 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 |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$47.73
|
|
|
Service Code
|
NDC 60687062845
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna American Axle |
$31.02
|
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: BCBS Complete |
$19.09
|
| 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 |
$17.66
|
| 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 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 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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna American Axle |
$13.35
|
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.35
|
| Rate for Payer: BCBS Complete |
$8.22
|
| 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 |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.40
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
NDC 60687034172
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna American Axle |
$40.62
|
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: Aetna Medicare |
$31.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.62
|
| Rate for Payer: BCBS Complete |
$25.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$43.75
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$56.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.12
|
| Rate for Payer: PHP Commercial |
$53.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.62
|
| Rate for Payer: Priority Health SBD |
$39.38
|
| Rate for Payer: UMR Bronson Commercial |
$23.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
NDC 60687034172
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna American Axle |
$40.62
|
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.62
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$43.75
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$56.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.12
|
| Rate for Payer: PHP Commercial |
$53.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.62
|
| Rate for Payer: Priority Health SBD |
$39.38
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$47.51
|
|
|
Service Code
|
NDC 00904746260
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$42.76 |
| Rate for Payer: Aetna American Axle |
$30.88
|
| Rate for Payer: Aetna Commercial |
$40.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.88
|
| Rate for Payer: Cash Price |
$38.01
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.01
|
| Rate for Payer: Healthscope Commercial |
$42.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.38
|
| Rate for Payer: PHP Commercial |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.88
|
| Rate for Payer: Priority Health SBD |
$29.93
|
| Rate for Payer: UMR Bronson Commercial |
$20.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.63
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$73.26
|
|
|
Service Code
|
NDC 66689004850
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$65.93 |
| Rate for Payer: Aetna American Axle |
$47.62
|
| Rate for Payer: Aetna Commercial |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.62
|
| 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 |
$32.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.95
|
|
