|
POSTERIOR CHAMBER INTRAOCULAR LENS
|
Facility
|
OP
|
$167.42
|
|
|
Service Code
|
CPT V2632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$167.42 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.42
|
| Rate for Payer: UHC Exchange |
$139.52
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.90 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,685.02
|
| Rate for Payer: BCN Commercial |
$4,685.02
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.69
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$597.90
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,812.50
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: BCBS Trust/PPO |
$2,812.50
|
| Rate for Payer: BCN Commercial |
$2,812.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.04
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$743.67
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,823.84
|
|
|
Service Code
|
CPT 22842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,823.84 |
| Rate for Payer: BCBS Trust/PPO |
$2,823.84
|
| Rate for Payer: BCN Commercial |
$2,823.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.57
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$751.43
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$1,322.75
|
|
|
Service Code
|
NDC 58657031116
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$582.01 |
| Max. Negotiated Rate |
$1,190.48 |
| Rate for Payer: Aetna American Axle |
$859.79
|
| Rate for Payer: Aetna Commercial |
$1,124.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.79
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Cofinity Commercial |
$1,137.56
|
| Rate for Payer: Cofinity Commercial |
$925.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$925.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,058.20
|
| Rate for Payer: Healthscope Commercial |
$1,190.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,124.34
|
| Rate for Payer: PHP Commercial |
$1,124.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.79
|
| Rate for Payer: Priority Health SBD |
$833.33
|
| Rate for Payer: UMR Bronson Commercial |
$582.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.06
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
OP
|
$1,322.75
|
|
|
Service Code
|
NDC 58657031116
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$489.42 |
| Max. Negotiated Rate |
$1,190.48 |
| Rate for Payer: Aetna American Axle |
$859.79
|
| Rate for Payer: Aetna Commercial |
$1,124.34
|
| Rate for Payer: Aetna Medicare |
$661.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.79
|
| Rate for Payer: BCBS Complete |
$529.10
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Cofinity Commercial |
$1,137.56
|
| Rate for Payer: Cofinity Commercial |
$925.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$925.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,058.20
|
| Rate for Payer: Healthscope Commercial |
$1,190.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,124.34
|
| Rate for Payer: PHP Commercial |
$1,124.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.79
|
| Rate for Payer: Priority Health SBD |
$833.33
|
| Rate for Payer: UMR Bronson Commercial |
$489.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.06
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$1,289.40
|
|
|
Service Code
|
NDC 60258000216
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$567.34 |
| Max. Negotiated Rate |
$1,160.46 |
| Rate for Payer: Aetna American Axle |
$838.11
|
| Rate for Payer: Aetna Commercial |
$1,095.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.11
|
| Rate for Payer: Cash Price |
$1,031.52
|
| Rate for Payer: Cofinity Commercial |
$1,108.88
|
| Rate for Payer: Cofinity Commercial |
$902.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.52
|
| Rate for Payer: Healthscope Commercial |
$1,160.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.99
|
| Rate for Payer: PHP Commercial |
$1,095.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.11
|
| Rate for Payer: Priority Health SBD |
$812.32
|
| Rate for Payer: UMR Bronson Commercial |
$567.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.05
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
OP
|
$1,289.40
|
|
|
Service Code
|
NDC 60258000216
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$477.08 |
| Max. Negotiated Rate |
$1,160.46 |
| Rate for Payer: Aetna American Axle |
$838.11
|
| Rate for Payer: Aetna Commercial |
$1,095.99
|
| Rate for Payer: Aetna Medicare |
$644.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.11
|
| Rate for Payer: BCBS Complete |
$515.76
|
| Rate for Payer: Cash Price |
$1,031.52
|
| Rate for Payer: Cofinity Commercial |
$1,108.88
|
| Rate for Payer: Cofinity Commercial |
$902.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.52
|
| Rate for Payer: Healthscope Commercial |
$1,160.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.99
|
| Rate for Payer: PHP Commercial |
$1,095.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.11
|
| Rate for Payer: Priority Health SBD |
$812.32
|
| Rate for Payer: UMR Bronson Commercial |
$477.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.05
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
OP
|
$289.01
|
|
|
Service Code
|
NDC 00121067716
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$260.11 |
| Rate for Payer: Aetna American Axle |
$187.86
|
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.86
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Cofinity Commercial |
$248.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$260.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.66
|
| Rate for Payer: PHP Commercial |
$245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.86
|
| Rate for Payer: Priority Health SBD |
$182.08
|
| Rate for Payer: UMR Bronson Commercial |
$106.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.76
|
|
|
POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN
|
Facility
|
IP
|
$289.01
|
|
|
Service Code
|
NDC 00121067716
|
| Hospital Charge Code |
11057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$260.11 |
| Rate for Payer: Aetna American Axle |
$187.86
|
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.86
|
| Rate for Payer: Cash Price |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Cofinity Commercial |
$248.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.21
|
| Rate for Payer: Healthscope Commercial |
$260.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.66
|
| Rate for Payer: PHP Commercial |
$245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.86
|
| Rate for Payer: Priority Health SBD |
$182.08
|
| Rate for Payer: UMR Bronson Commercial |
$127.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.76
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 51754200401
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.05
|
|
|
Service Code
|
NDC 51754200104
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
NDC 00409818315
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.05
|
|
|
Service Code
|
NDC 51754200104
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
NDC 51754200404
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818315
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
NDC 51754200404
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329461
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
NDC 00409818325
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.50
|
| Rate for Payer: PHP Commercial |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health SBD |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.32
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329451
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329451
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
