|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409329915
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Exchange |
$8.49
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409329915
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409329905
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.07
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: UHC Exchange |
$10.32
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Core |
$11.26
|
| Rate for Payer: UHC Exchange |
$8.49
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.70
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health SBD |
$16.54
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409329905
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.44
|
| Rate for Payer: UHC Core |
$9.97
|
| Rate for Payer: UHC Exchange |
$7.52
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$64.97
|
|
|
Service Code
|
NDC 09900001916
|
| Hospital Charge Code |
300441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$58.47 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.23
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Advantage |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$55.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.73
|
| Rate for Payer: PHP Commercial |
$55.22
|
| Rate for Payer: Priority Health SBD |
$40.93
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$64.97
|
|
|
Service Code
|
NDC 09900001916
|
| Hospital Charge Code |
300441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$58.47 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Medicare |
$32.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.23
|
| Rate for Payer: BCBS Complete |
$25.99
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Advantage |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$55.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.73
|
| Rate for Payer: PHP Commercial |
$55.22
|
| Rate for Payer: Priority Health SBD |
$40.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.23
|
| Rate for Payer: UHC Core |
$33.85
|
| Rate for Payer: UHC Exchange |
$25.53
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$102.80
|
|
|
Service Code
|
NDC 63323008950
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: Aetna Medicare |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.82
|
| Rate for Payer: BCBS Complete |
$41.12
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cofinity Advantage |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$92.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.10
|
| Rate for Payer: PHP Commercial |
$87.38
|
| Rate for Payer: Priority Health SBD |
$64.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.82
|
| Rate for Payer: UHC Core |
$53.56
|
| Rate for Payer: UHC Exchange |
$40.40
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.03
|
| Rate for Payer: UHC Core |
$11.25
|
| Rate for Payer: UHC Exchange |
$8.48
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$30.44 |
| Rate for Payer: Aetna Commercial |
$28.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.98
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Advantage |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: PHP Commercial |
$28.75
|
| Rate for Payer: Priority Health SBD |
$21.31
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
NDC 81665020001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$59.27 |
| Rate for Payer: Aetna Commercial |
$55.98
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.81
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Advantage |
$46.10
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$59.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: PHP Commercial |
$55.98
|
| Rate for Payer: Priority Health SBD |
$41.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$34.31
|
| Rate for Payer: UHC Exchange |
$25.88
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$30.44 |
| Rate for Payer: Aetna Commercial |
$28.75
|
| Rate for Payer: Aetna Medicare |
$16.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.98
|
| Rate for Payer: BCBS Complete |
$13.53
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Advantage |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$30.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: PHP Commercial |
$28.75
|
| Rate for Payer: Priority Health SBD |
$21.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.98
|
| Rate for Payer: UHC Core |
$17.62
|
| Rate for Payer: UHC Exchange |
$13.29
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.59
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cofinity Advantage |
$15.11
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.19
|
| Rate for Payer: PHP Commercial |
$18.35
|
| Rate for Payer: Priority Health SBD |
$13.60
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.81
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Aetna Commercial |
$20.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.48
|
| Rate for Payer: Cash Price |
$19.05
|
| Rate for Payer: Cofinity Advantage |
$16.67
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.86
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: Priority Health SBD |
$15.00
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.14
|
| Rate for Payer: UHC Core |
$18.55
|
| Rate for Payer: UHC Exchange |
$13.99
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 00409662514
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.14
|
| Rate for Payer: UHC Core |
$18.55
|
| Rate for Payer: UHC Exchange |
$13.99
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.14
|
|
|
Service Code
|
NDC 68462095150
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$11.01
|
| Rate for Payer: UHC Exchange |
$8.31
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662522
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.14
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Advantage |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health SBD |
$22.43
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.38
|
|
|
Service Code
|
NDC 70095005003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$33.64 |
| Rate for Payer: Aetna Commercial |
$31.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.30
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cofinity Advantage |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$32.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.90
|
| Rate for Payer: Healthscope Commercial |
$33.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.04
|
| Rate for Payer: PHP Commercial |
$31.77
|
| Rate for Payer: Priority Health SBD |
$23.55
|
|
