|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| 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: 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
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.58
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$68.21
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna Medicare |
$9.13
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| 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) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.08
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$32.10
|
| Rate for Payer: BCBS Complete |
$7.43
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$13.01
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$56.17
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.20
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$72.22
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$15.79
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$68.21
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health SBD |
$50.56
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: Priority Health SBD |
$11.71
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$16.99
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Commercial |
$68.21
|
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.01
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$56.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.20
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$72.22
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$15.79
|
| Rate for Payer: PHP Commercial |
$68.21
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.60
|
| Rate for Payer: Priority Health SBD |
$50.56
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$11.71
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$13.29
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$668.75
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
300444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$601.88 |
| Rate for Payer: Aetna Commercial |
$568.44
|
| Rate for Payer: Aetna Medicare |
$334.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.69
|
| Rate for Payer: BCBS Complete |
$267.50
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cofinity Commercial |
$468.12
|
| Rate for Payer: Cofinity Commercial |
$575.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.00
|
| Rate for Payer: Healthscope Commercial |
$601.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.44
|
| Rate for Payer: PHP Commercial |
$568.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.69
|
| Rate for Payer: Priority Health SBD |
$421.31
|
|
|
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: Cofinity Medicare Advantage |
$468.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.00
|
| Rate for Payer: Healthscope Commercial |
$601.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.44
|
| Rate for Payer: PHP Commercial |
$568.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.69
|
| Rate for Payer: Priority Health SBD |
$421.31
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
NDC 00904693061
|
| Hospital Charge Code |
13644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.86 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health SBD |
$183.86
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
NDC 00904693061
|
| Hospital Charge Code |
13644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$145.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: BCBS Complete |
$116.74
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health SBD |
$183.86
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| 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 |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health SBD |
$164.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$218.03 |
| 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 |
$169.57
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: Priority Health SBD |
$152.62
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687046611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 70010002201
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$113.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: BCBS Complete |
$91.18
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health SBD |
$143.61
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: Aetna Medicare |
$121.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$169.57
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: Priority Health SBD |
$152.62
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$311.60
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.54
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.86
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.54
|
| Rate for Payer: Priority Health SBD |
$196.31
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687046611
|
| 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 |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$311.60
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.64 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: Aetna Medicare |
$155.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.54
|
| Rate for Payer: BCBS Complete |
$124.64
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.86
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.54
|
| Rate for Payer: Priority Health SBD |
$196.31
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.38 |
| Max. Negotiated Rate |
$241.97 |
| 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 |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 70010002201
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.17
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health SBD |
$143.61
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health SBD |
$164.34
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
IP
|
$78.44
|
|
|
Service Code
|
NDC 00178031430
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Commercial |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
OP
|
$5.63
|
|
|
Service Code
|
NDC 09900001948
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.66
|
| Rate for Payer: Priority Health SBD |
$3.55
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
OP
|
$78.44
|
|
|
Service Code
|
NDC 00178031430
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: Aetna Medicare |
$39.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: BCBS Complete |
$31.38
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Commercial |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
POTASSIUM IODIDE 65 MG/ML ORAL DROPS
|
Facility
|
IP
|
$5.63
|
|
|
Service Code
|
NDC 09900001948
|
| Hospital Charge Code |
113247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.66
|
| Rate for Payer: Priority Health SBD |
$3.55
|
|
