|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.24
|
| Rate for Payer: BCN Commercial |
$7.24
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$87.40
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$78.66 |
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$61.18
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$45.22
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$71.78
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.22 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$74.29
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$61.18
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$74.29
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$55.06
|
| Rate for Payer: Priority Health SBD |
$45.22
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$43.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$30.71
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$37.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$37.29
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.52
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$27.64
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$43.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna Medicare |
$21.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Complete |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cofinity Commercial |
$30.71
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$37.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.29
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$37.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: Priority Health SBD |
$27.64
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.76
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health SBD |
$2.76
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 00223176001
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health SBD |
$139.17
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 00223176001
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$110.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health SBD |
$139.17
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.37 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 76204002260
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.70
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.70
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 76204002260
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
NDC 00409114112
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
NDC 00409114102
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$132.98 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health SBD |
$93.08
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$132.98 |
| Rate for Payer: Aetna Commercial |
$125.59
|
| Rate for Payer: Aetna Medicare |
$73.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.04
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: PHP Commercial |
$125.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health SBD |
$93.08
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
NDC 00409114112
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
NDC 00409114102
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
NDC 09900001915
|
| Hospital Charge Code |
300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
