POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
11076
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$72.37 |
Rate for Payer: Aetna Commercial |
$68.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
Rate for Payer: BCBS Complete |
$32.16
|
Rate for Payer: BCBS Trust/PPO |
$0.35
|
Rate for Payer: Cash Price |
$64.33
|
Rate for Payer: Cash Price |
$64.33
|
Rate for Payer: Cofinity Commercial |
$56.29
|
Rate for Payer: Cofinity Commercial |
$69.15
|
Rate for Payer: Healthscope Commercial |
$72.37
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
Rate for Payer: PHP Commercial |
$68.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
Rate for Payer: Priority Health SBD |
$50.66
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$151.27
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
11076
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$95.30 |
Max. Negotiated Rate |
$136.14 |
Rate for Payer: Aetna Commercial |
$128.58
|
Rate for Payer: Aetna Commercial |
$68.35
|
Rate for Payer: Aetna Commercial |
$47.46
|
Rate for Payer: Aetna Commercial |
$66.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$50.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
Rate for Payer: Aetna New Business (MI Preferred) |
$98.33
|
Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
Rate for Payer: Cash Price |
$44.66
|
Rate for Payer: Cash Price |
$62.53
|
Rate for Payer: Cash Price |
$64.33
|
Rate for Payer: Cash Price |
$121.02
|
Rate for Payer: Cofinity Commercial |
$67.22
|
Rate for Payer: Cofinity Commercial |
$39.08
|
Rate for Payer: Cofinity Commercial |
$48.01
|
Rate for Payer: Cofinity Commercial |
$69.15
|
Rate for Payer: Cofinity Commercial |
$56.29
|
Rate for Payer: Cofinity Commercial |
$105.89
|
Rate for Payer: Cofinity Commercial |
$54.71
|
Rate for Payer: Cofinity Commercial |
$130.09
|
Rate for Payer: Healthscope Commercial |
$50.25
|
Rate for Payer: Healthscope Commercial |
$72.37
|
Rate for Payer: Healthscope Commercial |
$136.14
|
Rate for Payer: Healthscope Commercial |
$70.34
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.58
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.46
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
Rate for Payer: PHP Commercial |
$66.44
|
Rate for Payer: PHP Commercial |
$128.58
|
Rate for Payer: PHP Commercial |
$47.46
|
Rate for Payer: PHP Commercial |
$68.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$54.71
|
Rate for Payer: Priority Health Cigna Priority Health |
$39.08
|
Rate for Payer: Priority Health Cigna Priority Health |
$105.89
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
Rate for Payer: Priority Health SBD |
$50.66
|
Rate for Payer: Priority Health SBD |
$49.24
|
Rate for Payer: Priority Health SBD |
$35.17
|
Rate for Payer: Priority Health SBD |
$95.30
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$45.40
|
|
Service Code
|
NDC 0904-7062-62
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$28.60 |
Max. Negotiated Rate |
$40.86 |
Rate for Payer: Aetna Commercial |
$38.59
|
Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
Rate for Payer: Cash Price |
$36.32
|
Rate for Payer: Cofinity Commercial |
$31.78
|
Rate for Payer: Cofinity Commercial |
$39.04
|
Rate for Payer: Healthscope Commercial |
$40.86
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
Rate for Payer: PHP Commercial |
$38.59
|
Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
Rate for Payer: Priority Health SBD |
$28.60
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$72.93
|
|
Service Code
|
NDC 66689-048-50
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$45.95 |
Max. Negotiated Rate |
$65.64 |
Rate for Payer: Aetna Commercial |
$61.99
|
Rate for Payer: Aetna New Business (MI Preferred) |
$47.40
|
Rate for Payer: Cash Price |
$58.34
|
Rate for Payer: Cofinity Commercial |
$51.05
|
Rate for Payer: Cofinity Commercial |
$62.72
|
Rate for Payer: Healthscope Commercial |
$65.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.99
|
Rate for Payer: PHP Commercial |
$61.99
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
Rate for Payer: Priority Health SBD |
$45.95
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$30.97
|
|
Service Code
|
NDC 0904-7062-73
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$19.51 |
Max. Negotiated Rate |
$27.87 |
Rate for Payer: Aetna Commercial |
$26.32
|
Rate for Payer: Aetna New Business (MI Preferred) |
$20.13
|
Rate for Payer: Cash Price |
$24.78
|
Rate for Payer: Cofinity Commercial |
$21.68
|
Rate for Payer: Cofinity Commercial |
$26.63
|
Rate for Payer: Healthscope Commercial |
$27.87
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.32
|
Rate for Payer: PHP Commercial |
$26.32
|
Rate for Payer: Priority Health Cigna Priority Health |
$21.68
|
Rate for Payer: Priority Health SBD |
$19.51
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$36.63
|
|
Service Code
|
NDC 0121-1896-00
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$23.08 |
Max. Negotiated Rate |
$32.97 |
Rate for Payer: Aetna Commercial |
$31.14
|
Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
Rate for Payer: Cash Price |
$29.30
|
Rate for Payer: Cofinity Commercial |
$25.64
|
Rate for Payer: Cofinity Commercial |
$31.50
|
Rate for Payer: Healthscope Commercial |
$32.97
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.14
|
Rate for Payer: PHP Commercial |
$31.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$25.64
|
Rate for Payer: Priority Health SBD |
$23.08
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$36.63
|
|
Service Code
|
NDC 0121-1896-30
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$23.08 |
Max. Negotiated Rate |
$32.97 |
Rate for Payer: Aetna Commercial |
$31.14
|
Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
Rate for Payer: Cash Price |
$29.30
|
Rate for Payer: Cofinity Commercial |
$31.50
|
Rate for Payer: Cofinity Commercial |
$25.64
|
Rate for Payer: Healthscope Commercial |
$32.97
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.14
|
Rate for Payer: PHP Commercial |
$31.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$25.64
|
Rate for Payer: Priority Health SBD |
$23.08
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$71.82
|
|
Service Code
|
NDC 66689-048-01
|
Hospital Charge Code |
6432
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$45.25 |
Max. Negotiated Rate |
$64.64 |
Rate for Payer: Aetna Commercial |
$61.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
Rate for Payer: Cash Price |
$57.46
|
Rate for Payer: Cofinity Commercial |
$50.27
|
Rate for Payer: Cofinity Commercial |
$61.77
|
Rate for Payer: Healthscope Commercial |
$64.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.05
|
Rate for Payer: PHP Commercial |
$61.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$50.27
|
Rate for Payer: Priority Health SBD |
$45.25
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$69.92
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
11081
|
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 Commercial |
$62.42
|
Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
Rate for Payer: Cash Price |
$55.94
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cofinity Commercial |
$48.94
|
Rate for Payer: Cofinity Commercial |
$51.41
|
Rate for Payer: Cofinity Commercial |
$63.16
|
Rate for Payer: Cofinity Commercial |
$60.13
|
Rate for Payer: Healthscope Commercial |
$66.10
|
Rate for Payer: Healthscope Commercial |
$62.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
Rate for Payer: PHP Commercial |
$62.42
|
Rate for Payer: PHP Commercial |
$59.43
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
Rate for Payer: Priority Health SBD |
$44.05
|
Rate for Payer: Priority Health SBD |
$46.27
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$73.44
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
11081
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$66.10 |
Rate for Payer: Aetna Commercial |
$62.42
|
Rate for Payer: Aetna Commercial |
$59.43
|
Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
Rate for Payer: BCBS Complete |
$27.97
|
Rate for Payer: BCBS Complete |
$29.38
|
Rate for Payer: BCBS Trust/PPO |
$0.35
|
Rate for Payer: BCBS Trust/PPO |
$0.35
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cash Price |
$55.94
|
Rate for Payer: Cash Price |
$55.94
|
Rate for Payer: Cofinity Commercial |
$51.41
|
Rate for Payer: Cofinity Commercial |
$48.94
|
Rate for Payer: Cofinity Commercial |
$63.16
|
Rate for Payer: Cofinity Commercial |
$60.13
|
Rate for Payer: Healthscope Commercial |
$66.10
|
Rate for Payer: Healthscope Commercial |
$62.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
Rate for Payer: PHP Commercial |
$59.43
|
Rate for Payer: PHP Commercial |
$62.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
Rate for Payer: Priority Health SBD |
$46.27
|
Rate for Payer: Priority Health SBD |
$44.05
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
Service Code
|
NDC 0338-0671-04
|
Hospital Charge Code |
300206
|
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: Healthscope Commercial |
$62.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
Rate for Payer: PHP Commercial |
$59.43
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
Rate for Payer: Priority Health SBD |
$44.05
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$69.92
|
|
Service Code
|
NDC 0338-0671-04
|
Hospital Charge Code |
9801
|
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 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: Healthscope Commercial |
$62.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
Rate for Payer: PHP Commercial |
$59.43
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
Rate for Payer: Priority Health SBD |
$44.05
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
Service Code
|
NDC 0338-0671-04
|
Hospital Charge Code |
9801
|
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: Healthscope Commercial |
$62.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
Rate for Payer: PHP Commercial |
$59.43
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
Rate for Payer: Priority Health SBD |
$44.05
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
6429
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$24.27 |
Rate for Payer: Aetna Commercial |
$22.92
|
Rate for Payer: Aetna Commercial |
$17.93
|
Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
Rate for Payer: BCBS Complete |
$8.44
|
Rate for Payer: BCBS Complete |
$10.79
|
Rate for Payer: BCBS Trust/PPO |
$0.35
|
Rate for Payer: BCBS Trust/PPO |
$0.35
|
Rate for Payer: Cash Price |
$21.58
|
Rate for Payer: Cash Price |
$16.87
|
Rate for Payer: Cash Price |
$16.87
|
Rate for Payer: Cash Price |
$21.58
|
Rate for Payer: Cofinity Commercial |
$23.19
|
Rate for Payer: Cofinity Commercial |
$18.14
|
Rate for Payer: Cofinity Commercial |
$14.76
|
Rate for Payer: Cofinity Commercial |
$18.88
|
Rate for Payer: Healthscope Commercial |
$18.98
|
Rate for Payer: Healthscope Commercial |
$24.27
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.93
|
Rate for Payer: PHP Commercial |
$22.92
|
Rate for Payer: PHP Commercial |
$17.93
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
Rate for Payer: Priority Health SBD |
$13.29
|
Rate for Payer: Priority Health SBD |
$16.99
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.27
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
6429
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.51 |
Max. Negotiated Rate |
$16.44 |
Rate for Payer: Aetna Commercial |
$15.53
|
Rate for Payer: Aetna Commercial |
$17.78
|
Rate for Payer: Aetna Commercial |
$68.21
|
Rate for Payer: Aetna Commercial |
$22.92
|
Rate for Payer: Aetna Commercial |
$16.80
|
Rate for Payer: Aetna Commercial |
$17.93
|
Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.16
|
Rate for Payer: Cash Price |
$16.87
|
Rate for Payer: Cash Price |
$16.74
|
Rate for Payer: Cash Price |
$21.58
|
Rate for Payer: Cash Price |
$15.81
|
Rate for Payer: Cash Price |
$14.62
|
Rate for Payer: Cash Price |
$64.20
|
Rate for Payer: Cofinity Commercial |
$56.18
|
Rate for Payer: Cofinity Commercial |
$14.64
|
Rate for Payer: Cofinity Commercial |
$17.99
|
Rate for Payer: Cofinity Commercial |
$13.83
|
Rate for Payer: Cofinity Commercial |
$23.19
|
Rate for Payer: Cofinity Commercial |
$18.88
|
Rate for Payer: Cofinity Commercial |
$12.79
|
Rate for Payer: Cofinity Commercial |
$69.02
|
Rate for Payer: Cofinity Commercial |
$16.99
|
Rate for Payer: Cofinity Commercial |
$15.71
|
Rate for Payer: Cofinity Commercial |
$14.76
|
Rate for Payer: Cofinity Commercial |
$18.14
|
Rate for Payer: Healthscope Commercial |
$16.44
|
Rate for Payer: Healthscope Commercial |
$18.98
|
Rate for Payer: Healthscope Commercial |
$72.22
|
Rate for Payer: Healthscope Commercial |
$17.78
|
Rate for Payer: Healthscope Commercial |
$18.83
|
Rate for Payer: Healthscope Commercial |
$24.27
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.21
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.53
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.78
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
Rate for Payer: PHP Commercial |
$17.93
|
Rate for Payer: PHP Commercial |
$17.78
|
Rate for Payer: PHP Commercial |
$68.21
|
Rate for Payer: PHP Commercial |
$16.80
|
Rate for Payer: PHP Commercial |
$15.53
|
Rate for Payer: PHP Commercial |
$22.92
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
Rate for Payer: Priority Health SBD |
$12.45
|
Rate for Payer: Priority Health SBD |
$16.99
|
Rate for Payer: Priority Health SBD |
$50.56
|
Rate for Payer: Priority Health SBD |
$13.18
|
Rate for Payer: Priority Health SBD |
$13.29
|
Rate for Payer: Priority Health SBD |
$11.51
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$668.75
|
|
Service Code
|
HCPCS J3480
|
Hospital Charge Code |
300444
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$421.31 |
Max. Negotiated Rate |
$601.88 |
Rate for Payer: Aetna Commercial |
$568.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$434.69
|
Rate for Payer: Cash Price |
$535.00
|
Rate for Payer: Cofinity Commercial |
$468.12
|
Rate for Payer: Cofinity Commercial |
$575.12
|
Rate for Payer: Healthscope Commercial |
$601.88
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.44
|
Rate for Payer: PHP Commercial |
$568.44
|
Rate for Payer: Priority Health Cigna Priority Health |
$468.12
|
Rate for Payer: Priority Health SBD |
$421.31
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$287.04
|
|
Service Code
|
NDC 0904-6930-61
|
Hospital Charge Code |
13644
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$114.82 |
Max. Negotiated Rate |
$258.34 |
Rate for Payer: Aetna Commercial |
$243.98
|
Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
Rate for Payer: BCBS Complete |
$114.82
|
Rate for Payer: Cash Price |
$229.63
|
Rate for Payer: Cofinity Commercial |
$200.93
|
Rate for Payer: Cofinity Commercial |
$246.85
|
Rate for Payer: Healthscope Commercial |
$258.34
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.98
|
Rate for Payer: PHP Commercial |
$243.98
|
Rate for Payer: Priority Health Cigna Priority Health |
$200.93
|
Rate for Payer: Priority Health SBD |
$180.84
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$287.04
|
|
Service Code
|
NDC 0904-6930-61
|
Hospital Charge Code |
13644
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$180.84 |
Max. Negotiated Rate |
$258.34 |
Rate for Payer: Aetna Commercial |
$243.98
|
Rate for Payer: Aetna New Business (MI Preferred) |
$186.58
|
Rate for Payer: Cash Price |
$229.63
|
Rate for Payer: Cofinity Commercial |
$200.93
|
Rate for Payer: Cofinity Commercial |
$246.85
|
Rate for Payer: Healthscope Commercial |
$258.34
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.98
|
Rate for Payer: PHP Commercial |
$243.98
|
Rate for Payer: Priority Health Cigna Priority Health |
$200.93
|
Rate for Payer: Priority Health SBD |
$180.84
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
Service Code
|
NDC 0832-5323-11
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$164.34 |
Max. Negotiated Rate |
$234.76 |
Rate for Payer: Aetna Commercial |
$221.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
Rate for Payer: Cash Price |
$208.68
|
Rate for Payer: Cofinity Commercial |
$182.60
|
Rate for Payer: Cofinity Commercial |
$224.33
|
Rate for Payer: Healthscope Commercial |
$234.76
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
Rate for Payer: PHP Commercial |
$221.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
Rate for Payer: Priority Health SBD |
$164.34
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
Service Code
|
NDC 60687-466-11
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.53 |
Max. Negotiated Rate |
$2.19 |
Rate for Payer: Aetna Commercial |
$2.07
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
Rate for Payer: Cash Price |
$1.94
|
Rate for Payer: Cofinity Commercial |
$2.09
|
Rate for Payer: Cofinity Commercial |
$1.70
|
Rate for Payer: Healthscope Commercial |
$2.19
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
Rate for Payer: PHP Commercial |
$2.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
Rate for Payer: Priority Health SBD |
$1.53
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$301.15
|
|
Service Code
|
NDC 66758-160-01
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$189.72 |
Max. Negotiated Rate |
$271.04 |
Rate for Payer: Aetna Commercial |
$255.98
|
Rate for Payer: Aetna New Business (MI Preferred) |
$195.75
|
Rate for Payer: Cash Price |
$240.92
|
Rate for Payer: Cofinity Commercial |
$210.80
|
Rate for Payer: Cofinity Commercial |
$258.99
|
Rate for Payer: Healthscope Commercial |
$271.04
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.98
|
Rate for Payer: PHP Commercial |
$255.98
|
Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
Rate for Payer: Priority Health SBD |
$189.72
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
Service Code
|
NDC 60687-466-01
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$152.62 |
Max. Negotiated Rate |
$218.02 |
Rate for Payer: Aetna Commercial |
$205.91
|
Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
Rate for Payer: Cash Price |
$193.80
|
Rate for Payer: Cofinity Commercial |
$169.58
|
Rate for Payer: Cofinity Commercial |
$208.34
|
Rate for Payer: Healthscope Commercial |
$218.02
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.91
|
Rate for Payer: PHP Commercial |
$205.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$169.58
|
Rate for Payer: Priority Health SBD |
$152.62
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
Service Code
|
NDC 0574-0275-11
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$169.38 |
Max. Negotiated Rate |
$241.96 |
Rate for Payer: Aetna Commercial |
$228.52
|
Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
Rate for Payer: Cash Price |
$215.08
|
Rate for Payer: Cofinity Commercial |
$188.20
|
Rate for Payer: Cofinity Commercial |
$231.21
|
Rate for Payer: Healthscope Commercial |
$241.96
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.52
|
Rate for Payer: PHP Commercial |
$228.52
|
Rate for Payer: Priority Health Cigna Priority Health |
$188.20
|
Rate for Payer: Priority Health SBD |
$169.38
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$336.30
|
|
Service Code
|
NDC 66758-160-13
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$134.52 |
Max. Negotiated Rate |
$302.67 |
Rate for Payer: Aetna Commercial |
$285.86
|
Rate for Payer: Aetna New Business (MI Preferred) |
$218.60
|
Rate for Payer: BCBS Complete |
$134.52
|
Rate for Payer: Cash Price |
$269.04
|
Rate for Payer: Cofinity Commercial |
$235.41
|
Rate for Payer: Cofinity Commercial |
$289.22
|
Rate for Payer: Healthscope Commercial |
$302.67
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.86
|
Rate for Payer: PHP Commercial |
$285.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$235.41
|
Rate for Payer: Priority Health SBD |
$211.87
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$336.30
|
|
Service Code
|
NDC 66758-160-13
|
Hospital Charge Code |
6436
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$211.87 |
Max. Negotiated Rate |
$302.67 |
Rate for Payer: Aetna Commercial |
$285.86
|
Rate for Payer: Aetna New Business (MI Preferred) |
$218.60
|
Rate for Payer: Cash Price |
$269.04
|
Rate for Payer: Cofinity Commercial |
$289.22
|
Rate for Payer: Cofinity Commercial |
$235.41
|
Rate for Payer: Healthscope Commercial |
$302.67
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.86
|
Rate for Payer: PHP Commercial |
$285.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$235.41
|
Rate for Payer: Priority Health SBD |
$211.87
|
|