|
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 |
$169.42 |
| 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 Advantage |
$301.76
|
| Rate for Payer: Cofinity Commercial |
$370.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.87
|
| Rate for Payer: Healthscope Commercial |
$387.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.32
|
| Rate for Payer: PHP Commercial |
$366.43
|
| Rate for Payer: Priority Health SBD |
$271.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.21
|
| Rate for Payer: UHC Core |
$224.60
|
| Rate for Payer: UHC Exchange |
$169.42
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$244.13
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$219.72 |
| Rate for Payer: Aetna Commercial |
$207.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.68
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cofinity Advantage |
$170.89
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.30
|
| Rate for Payer: Healthscope Commercial |
$219.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.10
|
| Rate for Payer: PHP Commercial |
$207.51
|
| Rate for Payer: Priority Health SBD |
$153.80
|
|
|
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 |
$298.60 |
| 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 Advantage |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.85
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health SBD |
$478.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.87
|
| Rate for Payer: UHC Core |
$395.86
|
| Rate for Payer: UHC Exchange |
$298.60
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$244.13
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$219.72 |
| Rate for Payer: Aetna Commercial |
$207.51
|
| Rate for Payer: Aetna Medicare |
$122.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.68
|
| Rate for Payer: BCBS Complete |
$97.65
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cofinity Advantage |
$170.89
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.30
|
| Rate for Payer: Healthscope Commercial |
$219.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.10
|
| Rate for Payer: PHP Commercial |
$207.51
|
| Rate for Payer: Priority Health SBD |
$153.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.68
|
| Rate for Payer: UHC Core |
$127.19
|
| Rate for Payer: UHC Exchange |
$95.94
|
|
|
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 Advantage |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| 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: Opus (Opus Packaging Group) HMA |
$307.98
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health SBD |
$258.70
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$239.10
|
|
|
Service Code
|
NDC 69097007767
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.97 |
| Max. Negotiated Rate |
$215.19 |
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Medicare |
$119.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: BCBS Complete |
$95.64
|
| Rate for Payer: Cash Price |
$191.28
|
| Rate for Payer: Cofinity Advantage |
$167.37
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.28
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.32
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: Priority Health SBD |
$150.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.41
|
| Rate for Payer: UHC Core |
$124.57
|
| Rate for Payer: UHC Exchange |
$93.97
|
|
|
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 |
$298.60 |
| 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 Advantage |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.84
|
| Rate for Payer: Healthscope Commercial |
$683.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.85
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health SBD |
$478.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.87
|
| Rate for Payer: UHC Core |
$395.86
|
| Rate for Payer: UHC Exchange |
$298.60
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.46 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.65
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Exchange |
$61.46
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$239.10
|
|
|
Service Code
|
NDC 69097007797
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.97 |
| Max. Negotiated Rate |
$215.19 |
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna Medicare |
$119.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: BCBS Complete |
$95.64
|
| Rate for Payer: Cash Price |
$191.28
|
| Rate for Payer: Cofinity Advantage |
$167.37
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.28
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.32
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: Priority Health SBD |
$150.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.41
|
| Rate for Payer: UHC Core |
$124.57
|
| Rate for Payer: UHC Exchange |
$93.97
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$244.13
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$219.72 |
| Rate for Payer: Aetna Commercial |
$207.51
|
| Rate for Payer: Aetna Medicare |
$122.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.68
|
| Rate for Payer: BCBS Complete |
$97.65
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cofinity Advantage |
$170.89
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.30
|
| Rate for Payer: Healthscope Commercial |
$219.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.10
|
| Rate for Payer: PHP Commercial |
$207.51
|
| Rate for Payer: Priority Health SBD |
$153.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.68
|
| Rate for Payer: UHC Core |
$127.19
|
| Rate for Payer: UHC Exchange |
$95.94
|
|
|
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 Advantage |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| 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: Opus (Opus Packaging Group) HMA |
$569.85
|
| Rate for Payer: PHP Commercial |
$645.83
|
| Rate for Payer: Priority Health SBD |
$478.67
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.46 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.65
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Exchange |
$61.46
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$239.10
|
|
|
Service Code
|
NDC 69097007767
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.63 |
| Max. Negotiated Rate |
$215.19 |
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: Cash Price |
$191.28
|
| Rate for Payer: Cofinity Advantage |
$167.37
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.28
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.32
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: Priority Health SBD |
$150.63
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$239.10
|
|
|
Service Code
|
NDC 69097007797
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.63 |
| Max. Negotiated Rate |
$215.19 |
| Rate for Payer: Aetna Commercial |
$203.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: Cash Price |
$191.28
|
| Rate for Payer: Cofinity Advantage |
$167.37
|
| Rate for Payer: Cofinity Commercial |
$205.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.28
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.32
|
| Rate for Payer: PHP Commercial |
$203.24
|
| Rate for Payer: Priority Health SBD |
$150.63
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$244.13
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$219.72 |
| Rate for Payer: Aetna Commercial |
$207.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.68
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cofinity Advantage |
$170.89
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.30
|
| Rate for Payer: Healthscope Commercial |
$219.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.10
|
| Rate for Payer: PHP Commercial |
$207.51
|
| Rate for Payer: Priority Health SBD |
$153.80
|
|
|
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 Advantage |
$531.86
|
| Rate for Payer: Cofinity Commercial |
$653.43
|
| 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: Opus (Opus Packaging Group) HMA |
$569.85
|
| Rate for Payer: PHP Commercial |
$645.83
|
| 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 |
$161.38 |
| 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 Advantage |
$287.45
|
| Rate for Payer: Cofinity Commercial |
$353.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$369.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.98
|
| Rate for Payer: PHP Commercial |
$349.04
|
| Rate for Payer: Priority Health SBD |
$258.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.92
|
| Rate for Payer: UHC Core |
$213.94
|
| Rate for Payer: UHC Exchange |
$161.38
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$156.39
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
|
|
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 Advantage |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| 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: Opus (Opus Packaging Group) HMA |
$583.30
|
| Rate for Payer: PHP Commercial |
$661.08
|
| 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 |
$305.65 |
| 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 Advantage |
$544.42
|
| Rate for Payer: Cofinity Commercial |
$668.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.19
|
| Rate for Payer: Healthscope Commercial |
$699.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.30
|
| Rate for Payer: PHP Commercial |
$661.08
|
| Rate for Payer: Priority Health SBD |
$489.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.53
|
| Rate for Payer: UHC Core |
$405.20
|
| Rate for Payer: UHC Exchange |
$305.65
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$21.29
|
|
|
Service Code
|
NDC 00395232516
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.37 |
| 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 Advantage |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.97
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health SBD |
$13.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$11.09
|
| Rate for Payer: UHC Exchange |
$8.37
|
|
|
POVIDONE-IODINE 10 % TOPICAL SOLUTION
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
NDC 52380190508
|
| Hospital Charge Code |
6458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| 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 Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health SBD |
$9.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$7.78
|
| Rate for Payer: UHC Exchange |
$5.87
|
|
|
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 Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| 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: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.70
|
| 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 Advantage |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| 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: Opus (Opus Packaging Group) HMA |
$15.97
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: Priority Health SBD |
$13.41
|
|
|
POVIDONE-IODINE 5 % EYE SOLUTION
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 00065041130
|
| Hospital Charge Code |
19791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$15.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Advantage |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.62
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: UHC Exchange |
$12.38
|
|
