|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Medicare |
$27.91
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna Medicare |
$75.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Complete |
$60.51
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$105.89
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Advantage |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: Priority Health SBD |
$95.30
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$27.98
|
|
|
Service Code
|
NDC 121189600
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$25.18 |
| Rate for Payer: Aetna Commercial |
$23.78
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$24.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.78
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.19
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Exchange |
$11.00
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 43598089116
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Exchange |
$3.67
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 43598089152
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 43598089116
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 43598089152
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.93
|
| Rate for Payer: Priority Health SBD |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Exchange |
$3.67
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$27.98
|
|
|
Service Code
|
NDC 121189630
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$25.18 |
| Rate for Payer: Aetna Commercial |
$23.78
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$24.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.78
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.19
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Exchange |
$11.00
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$111.65
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Aetna Commercial |
$94.90
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna Medicare |
$55.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$78.16
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.57
|
| Rate for Payer: UHC Core |
$58.17
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Exchange |
$27.48
|
|
|
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 |
$94.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Advantage |
$78.16
|
| Rate for Payer: Cofinity Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$70.34
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.48 |
| 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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| 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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| 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 338067104
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.48 |
| 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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.48 |
| 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 Advantage |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.45
|
| Rate for Payer: UHC Core |
$36.43
|
| Rate for Payer: UHC Exchange |
$27.48
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.27
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Commercial |
$77.78
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Medicare |
$7.84
|
| Rate for Payer: Aetna Medicare |
$9.13
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna Medicare |
$45.75
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.08
|
| Rate for Payer: BCBS Complete |
$7.43
|
| Rate for Payer: BCBS Complete |
$36.60
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Advantage |
$14.64
|
| Rate for Payer: Cofinity Advantage |
$64.05
|
| Rate for Payer: Cofinity Advantage |
$13.01
|
| Rate for Payer: Cofinity Advantage |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$78.69
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$82.35
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.62
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$15.79
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: PHP Commercial |
$77.78
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$57.65
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$11.71
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
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 |
$77.78
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cofinity Advantage |
$14.64
|
| Rate for Payer: Cofinity Advantage |
$10.98
|
| Rate for Payer: Cofinity Advantage |
$64.05
|
| Rate for Payer: Cofinity Advantage |
$12.79
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Advantage |
$13.01
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.49
|
| Rate for Payer: Cofinity Commercial |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$78.69
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.55
|
| 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 |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.20
|
| Rate for Payer: Healthscope Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$82.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$15.79
|
| Rate for Payer: PHP Commercial |
$13.34
|
| Rate for Payer: PHP Commercial |
$77.78
|
| Rate for Payer: Priority Health SBD |
$11.71
|
| Rate for Payer: Priority Health SBD |
$13.18
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$57.65
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$762.50
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
300444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$480.38 |
| Max. Negotiated Rate |
$686.25 |
| Rate for Payer: Aetna Commercial |
$648.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.62
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cofinity Advantage |
$533.75
|
| Rate for Payer: Cofinity Commercial |
$655.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.00
|
| Rate for Payer: Healthscope Commercial |
$686.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.88
|
| Rate for Payer: PHP Commercial |
$648.12
|
| Rate for Payer: Priority Health SBD |
$480.38
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$762.50
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
300444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$686.25 |
| Rate for Payer: Aetna Commercial |
$648.12
|
| Rate for Payer: Aetna Medicare |
$381.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.62
|
| Rate for Payer: BCBS Complete |
$305.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cofinity Advantage |
$533.75
|
| Rate for Payer: Cofinity Commercial |
$655.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.00
|
| Rate for Payer: Healthscope Commercial |
$686.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$610.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.88
|
| Rate for Payer: PHP Commercial |
$648.12
|
| Rate for Payer: Priority Health SBD |
$480.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
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 |
$114.69 |
| 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 Advantage |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.88
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health SBD |
$183.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.70
|
| Rate for Payer: UHC Core |
$152.05
|
| Rate for Payer: UHC Exchange |
$114.69
|
|
|
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 Advantage |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| 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: Opus (Opus Packaging Group) HMA |
$218.88
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health SBD |
$183.86
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 72888007501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Advantage |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health SBD |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.83
|
| Rate for Payer: UHC Core |
$148.15
|
| Rate for Payer: UHC Exchange |
$111.75
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$181.64
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$227.05
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.04 |
| Max. Negotiated Rate |
$204.34 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.58
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Advantage |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$195.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$204.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: PHP Commercial |
$192.99
|
| Rate for Payer: Priority Health SBD |
$143.04
|
|
