|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$410.61 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: BCBS Trust/PPO |
$520.28
|
| Rate for Payer: BCN Commercial |
$520.28
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.45
|
| Rate for Payer: UHC Core |
$562.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$784.98
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$478.76 |
| Max. Negotiated Rate |
$706.48 |
| Rate for Payer: Aetna Commercial |
$667.23
|
| Rate for Payer: Aetna Commercial |
$646.99
|
| Rate for Payer: BCBS Trust/PPO |
$588.22
|
| Rate for Payer: BCBS Trust/PPO |
$606.63
|
| Rate for Payer: BCN Commercial |
$588.22
|
| Rate for Payer: BCN Commercial |
$606.63
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Cash Price |
$627.98
|
| Rate for Payer: Cofinity Commercial |
$675.08
|
| Rate for Payer: Cofinity Commercial |
$654.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.93
|
| Rate for Payer: Healthscope Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$706.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.23
|
| Rate for Payer: PHP Commercial |
$646.99
|
| Rate for Payer: PHP Commercial |
$667.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$662.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$464.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$690.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.82
|
| Rate for Payer: UHC Core |
$635.57
|
| Rate for Payer: UHC Core |
$655.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.74
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$374.95
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
11037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.68 |
| Max. Negotiated Rate |
$337.46 |
| Rate for Payer: Aetna Commercial |
$318.71
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$299.96
|
| Rate for Payer: Cofinity Commercial |
$322.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.96
|
| Rate for Payer: Healthscope Commercial |
$337.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.71
|
| Rate for Payer: PHP Commercial |
$318.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.96
|
| Rate for Payer: UHC Core |
$313.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.21
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER
|
Facility
|
IP
|
$17.14
|
|
|
Service Code
|
NDC 45802-868-01
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna Commercial |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.25
|
| Rate for Payer: BCN Commercial |
$13.25
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.57
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.08
|
| Rate for Payer: UHC Core |
$14.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.86
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.77
|
|
|
Service Code
|
NDC 11523-7234-1
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.42
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.75
|
| Rate for Payer: PHP Commercial |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.96
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.08
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084-430-98
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.01
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.41
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$186.34
|
|
|
Service Code
|
NDC 0904-6931-76
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$167.71 |
| Rate for Payer: Aetna Commercial |
$158.39
|
| Rate for Payer: BCBS Trust/PPO |
$144.00
|
| Rate for Payer: BCN Commercial |
$144.00
|
| Rate for Payer: Cash Price |
$149.07
|
| Rate for Payer: Cofinity Commercial |
$160.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.07
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.39
|
| Rate for Payer: PHP Commercial |
$158.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.98
|
| Rate for Payer: UHC Core |
$155.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.76
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.49
|
|
|
Service Code
|
NDC 0904-6931-86
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna Commercial |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$5.02
|
| Rate for Payer: BCN Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.19
|
| Rate for Payer: Healthscope Commercial |
$5.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.52
|
| Rate for Payer: PHP Commercial |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.71
|
| Rate for Payer: UHC Core |
$5.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.87
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$67.64
|
|
|
Service Code
|
NDC 11523-7268-3
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cofinity Commercial |
$58.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.11
|
| Rate for Payer: Healthscope Commercial |
$60.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.52
|
| Rate for Payer: UHC Core |
$56.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.73
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$605.28
|
|
|
Service Code
|
NDC 60687-431-92
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$544.75 |
| Rate for Payer: Aetna Commercial |
$514.49
|
| Rate for Payer: BCBS Trust/PPO |
$467.76
|
| Rate for Payer: BCN Commercial |
$467.76
|
| Rate for Payer: Cash Price |
$484.22
|
| Rate for Payer: Cofinity Commercial |
$520.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.22
|
| Rate for Payer: Healthscope Commercial |
$544.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.49
|
| Rate for Payer: PHP Commercial |
$514.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.65
|
| Rate for Payer: UHC Core |
$505.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.96
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$201.60
|
|
|
Service Code
|
NDC 51079-306-30
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.96 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$171.36
|
| Rate for Payer: BCBS Trust/PPO |
$155.80
|
| Rate for Payer: BCN Commercial |
$155.80
|
| Rate for Payer: Cash Price |
$161.28
|
| Rate for Payer: Cofinity Commercial |
$173.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.28
|
| Rate for Payer: Healthscope Commercial |
$181.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.36
|
| Rate for Payer: PHP Commercial |
$171.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.41
|
| Rate for Payer: UHC Core |
$168.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.20
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.06
|
|
|
Service Code
|
NDC 60687-431-99
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$5.15
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.85
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.15
|
| Rate for Payer: PHP Commercial |
$5.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.33
|
| Rate for Payer: UHC Core |
$5.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.54
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084-430-99
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Commercial |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.01
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$60.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.41
|
| Rate for Payer: PHP Commercial |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.50
|
| Rate for Payer: UHC Core |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.42
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
NDC 51079-306-01
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Commercial |
$5.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.71
|
| Rate for Payer: PHP Commercial |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.91
|
| Rate for Payer: UHC Core |
$5.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.04
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$45.44
|
|
|
Service Code
|
NDC 63323-367-11
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$35.12
|
| Rate for Payer: BCN Commercial |
$35.12
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.35
|
| Rate for Payer: Healthscope Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.62
|
| Rate for Payer: PHP Commercial |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.99
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.08
|
|
|
POTASSIUM ACETATE 20 MEQ/100 ML (IVPB PREMIX)
|
Facility
|
IP
|
$59.44
|
|
|
Service Code
|
NDC 9900-0010-94
|
| Hospital Charge Code |
300104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: BCBS Trust/PPO |
$45.94
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: Cash Price |
$47.55
|
| Rate for Payer: Cofinity Commercial |
$51.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.55
|
| Rate for Payer: Healthscope Commercial |
$53.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.52
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.31
|
| Rate for Payer: UHC Core |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.58
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.72
|
|
|
Service Code
|
NDC 0409-8183-01
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna Commercial |
$17.61
|
| Rate for Payer: BCBS Trust/PPO |
$16.01
|
| Rate for Payer: BCN Commercial |
$16.01
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: PHP Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.54
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 0409-3294-25
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$29.75
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$33.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$34.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.88
|
| Rate for Payer: UHC Core |
$32.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.88
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$78.16
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.67 |
| Max. Negotiated Rate |
$70.34 |
| Rate for Payer: Aetna Commercial |
$66.44
|
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: BCBS Trust/PPO |
$116.90
|
| Rate for Payer: BCBS Trust/PPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$60.40
|
| Rate for Payer: BCN Commercial |
$116.90
|
| Rate for Payer: BCN Commercial |
$62.14
|
| Rate for Payer: BCN Commercial |
$60.40
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Cofinity Commercial |
$67.22
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Healthscope Commercial |
$70.34
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Commercial |
$66.44
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.12
|
| Rate for Payer: UHC Core |
$67.14
|
| Rate for Payer: UHC Core |
$126.31
|
| Rate for Payer: UHC Core |
$65.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 0121-1680-15
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.94
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687-341-44
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$37.23
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$48.18
|
|
|
Service Code
|
NDC 60687-341-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$43.36 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: BCBS Trust/PPO |
$37.23
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$38.54
|
| Rate for Payer: Cofinity Commercial |
$41.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.54
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.95
|
| Rate for Payer: PHP Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.14
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$11.83
|
|
|
Service Code
|
NDC 50268-674-15
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.14
|
| Rate for Payer: BCN Commercial |
$9.14
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$10.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$10.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.06
|
| Rate for Payer: PHP Commercial |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.41
|
| Rate for Payer: UHC Core |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.87
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
NDC 0904-7061-87
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.30
|
| Rate for Payer: UHC Core |
$20.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.15
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0904-7061-88
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Commercial |
$14.63
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.09
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.66
|
| Rate for Payer: UHC Core |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
|
