|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 0121-1680-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
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 60687-341-71
|
| 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
|
$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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$25.48
|
|
|
Service Code
|
NDC 60687-628-44
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$22.93 |
| Rate for Payer: Aetna Commercial |
$21.66
|
| Rate for Payer: BCBS Trust/PPO |
$19.69
|
| Rate for Payer: BCN Commercial |
$19.69
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$21.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.66
|
| Rate for Payer: PHP Commercial |
$21.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.42
|
| Rate for Payer: UHC Core |
$21.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.11
|
|
|
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
|
$17.54
|
|
|
Service Code
|
NDC 66689-047-50
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$13.55
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0704-34
|
| Hospital Charge Code |
36046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
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 |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| 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: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219-118-10
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$70.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 65219-118-01
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$70.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| 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: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$55.94
|
| 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: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
NDC 0264-7635-00
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$61.63
|
| Rate for Payer: BCN Commercial |
$61.63
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.79
|
| Rate for Payer: PHP Commercial |
$67.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.18
|
| Rate for Payer: UHC Core |
$66.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.81
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.31
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$24.58 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCBS Trust/PPO |
$21.11
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: BCN Commercial |
$21.11
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cash Price |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$24.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.78
|
| Rate for Payer: PHP Commercial |
$17.78
|
| Rate for Payer: PHP Commercial |
$23.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Core |
$17.47
|
| Rate for Payer: UHC Core |
$22.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.48
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0695-04
|
| Hospital Charge Code |
11082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0807-04
|
| Hospital Charge Code |
9796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$311.60
|
|
|
Service Code
|
NDC 0245-5316-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.04 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna Commercial |
$264.86
|
| Rate for Payer: BCBS Trust/PPO |
$240.80
|
| Rate for Payer: BCN Commercial |
$240.80
|
| Rate for Payer: Cash Price |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$267.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.28
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.86
|
| Rate for Payer: PHP Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.21
|
| Rate for Payer: UHC Core |
$260.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.70
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 0574-0275-00
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$336.30
|
|
|
Service Code
|
NDC 66758-160-13
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.11 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna Commercial |
$285.86
|
| Rate for Payer: BCBS Trust/PPO |
$259.89
|
| Rate for Payer: BCN Commercial |
$259.89
|
| Rate for Payer: Cash Price |
$269.04
|
| Rate for Payer: Cofinity Commercial |
$289.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.04
|
| Rate for Payer: Healthscope Commercial |
$302.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.86
|
| Rate for Payer: PHP Commercial |
$285.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.94
|
| Rate for Payer: UHC Core |
$280.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.22
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 0245-5316-89
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687-466-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$218.02 |
| Rate for Payer: Aetna Commercial |
$205.91
|
| Rate for Payer: BCBS Trust/PPO |
$187.21
|
| Rate for Payer: BCN Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$218.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.91
|
| Rate for Payer: PHP Commercial |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.18
|
| Rate for Payer: UHC Core |
$202.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.69
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 0574-0275-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.97 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: BCBS Trust/PPO |
$207.77
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.59
|
| Rate for Payer: UHC Core |
$224.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-466-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.14
|
| Rate for Payer: UHC Core |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.82
|
|
