|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna Medicare |
$215.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002410
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.59 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
NDC 46287002410
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna Medicare |
$215.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
|
POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN
|
Facility
|
IP
|
$431.09
|
|
|
Service Code
|
NDC 46287002415
|
| Hospital Charge Code |
193046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.59 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$366.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.21
|
| Rate for Payer: Cash Price |
$344.87
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.21
|
| Rate for Payer: Priority Health SBD |
$271.59
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.06
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna Medicare |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: BCBS Complete |
$76.82
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$759.80
|
|
|
Service Code
|
NDC 65219005609
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.92 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna Medicare |
$379.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: BCBS Complete |
$303.92
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.26 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna Medicare |
$205.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: BCBS Complete |
$164.26
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: Priority Health SBD |
$258.70
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$759.80
|
|
|
Service Code
|
NDC 65219005629
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.92 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna Medicare |
$379.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: BCBS Complete |
$303.92
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$192.06
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna Medicare |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: BCBS Complete |
$76.82
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219005629
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$478.67 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.06
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$759.80
|
|
|
Service Code
|
NDC 65219005609
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$478.67 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Commercial |
$645.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.87
|
| Rate for Payer: Cash Price |
$607.84
|
| Rate for Payer: Cofinity Commercial |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.87
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$179.50 |
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: Aetna Medicare |
$99.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.64
|
| Rate for Payer: BCBS Complete |
$79.78
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$139.62
|
| Rate for Payer: Cofinity Commercial |
$171.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: PHP Commercial |
$169.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health SBD |
$125.65
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$179.50 |
| Rate for Payer: Aetna Commercial |
$169.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.64
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$139.62
|
| Rate for Payer: Cofinity Commercial |
$171.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: PHP Commercial |
$169.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health SBD |
$125.65
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.06
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$172.85 |
| Rate for Payer: Aetna Commercial |
$163.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.84
|
| Rate for Payer: Cash Price |
$153.65
|
| Rate for Payer: Cofinity Commercial |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$165.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.65
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.25
|
| Rate for Payer: PHP Commercial |
$163.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.84
|
| Rate for Payer: Priority Health SBD |
$121.00
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$258.70 |
| Max. Negotiated Rate |
$369.58 |
| Rate for Payer: Aetna Commercial |
$349.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.92
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: Priority Health SBD |
$258.70
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$777.74
|
|
|
Service Code
|
NDC 09900001921
|
| Hospital Charge Code |
301289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$489.98 |
| Max. Negotiated Rate |
$699.97 |
| Rate for Payer: Aetna Commercial |
$661.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.53
|
| Rate for Payer: Cash Price |
$622.19
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.19
|
| Rate for Payer: Healthscope Commercial |
$699.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.08
|
| Rate for Payer: PHP Commercial |
$661.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.53
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$777.74
|
|
|
Service Code
|
NDC 09900001921
|
| Hospital Charge Code |
301289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$311.10 |
| Max. Negotiated Rate |
$699.97 |
| Rate for Payer: Aetna Commercial |
$661.08
|
| Rate for Payer: Aetna Medicare |
$388.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.53
|
| Rate for Payer: BCBS Complete |
$311.10
|
| Rate for Payer: Cash Price |
$622.19
|
| Rate for Payer: Cofinity Commercial |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.19
|
| Rate for Payer: Healthscope Commercial |
$699.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.08
|
| Rate for Payer: PHP Commercial |
$661.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.53
|
| Rate for Payer: Priority Health SBD |
$489.98
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.98
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.10
|
| Rate for Payer: Aetna Medicare |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.84
|
| Rate for Payer: BCBS Complete |
$8.52
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.84
|
| Rate for Payer: Priority Health SBD |
$13.41
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
IP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Commercial |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$9.41
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
IP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
OP
|
$33.39
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$28.38
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.71
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.38
|
| Rate for Payer: PHP Commercial |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.04
|
|
|
PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$839.20 |
| Max. Negotiated Rate |
$1,784.60 |
| Rate for Payer: Aetna Commercial |
$1,292.63
|
| Rate for Payer: Aetna Medicare |
$1,003.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.63
|
| Rate for Payer: BCBS Complete |
$839.20
|
| Rate for Payer: BCBS MAPPO |
$964.65
|
| Rate for Payer: BCN Medicare Advantage |
$964.65
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,389.10
|
| Rate for Payer: Cofinity Commercial |
$1,292.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.65
|
| Rate for Payer: Healthscope Commercial |
$1,784.60
|
| Rate for Payer: Healthscope Commercial |
$1,543.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.70
|
| Rate for Payer: Nomi Health Commercial |
$1,157.58
|
| Rate for Payer: PACE SWMI |
$964.65
|
| Rate for Payer: PHP Medicare Advantage |
$964.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.70
|
| Rate for Payer: Priority Health Medicare |
$964.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.65
|
| Rate for Payer: UHC Medicare Advantage |
$964.65
|
|
