|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$43.27
|
| Rate for Payer: BCN Commercial |
$43.27
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| 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 HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
IP
|
$58.23
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.51 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.27
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: BCN Commercial |
$43.27
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$52.41
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: UHC Core |
$48.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.67
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.53
|
| Rate for Payer: UHC Core |
$56.10
|
| Rate for Payer: UHC Core |
$58.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$43.27
|
| Rate for Payer: BCN Commercial |
$43.27
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.27
|
| Rate for Payer: UHC Core |
$46.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: BCBS Trust/PPO |
$43.15
|
| Rate for Payer: BCN Commercial |
$43.15
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.46
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.13
|
| Rate for Payer: UHC Core |
$46.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.87
|
|
|
SODIUM CHLORIDE 0.9 % TOPICAL SPRAY
|
Facility
IP
|
$22.05
|
|
|
Service Code
|
NDC 22600-0085-52
|
| Hospital Charge Code |
109676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.74
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.40
|
| Rate for Payer: UHC Core |
$18.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.54
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.30
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0054-03
|
| Hospital Charge Code |
7321
|
|
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
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$103.50
|
|
|
Service Code
|
NDC 63323-187-30
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: BCBS Trust/PPO |
$79.98
|
| Rate for Payer: BCN Commercial |
$79.98
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cofinity Commercial |
$89.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.80
|
| Rate for Payer: Healthscope Commercial |
$93.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.98
|
| Rate for Payer: PHP Commercial |
$87.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.08
|
| Rate for Payer: UHC Core |
$86.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.62
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$17.82
|
|
|
Service Code
|
NDC 121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.77
|
| Rate for Payer: BCN Commercial |
$13.77
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.68
|
| Rate for Payer: UHC Core |
$14.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.36
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$17.82
|
|
|
Service Code
|
NDC 121059500
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.77
|
| Rate for Payer: BCN Commercial |
$13.77
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.68
|
| Rate for Payer: UHC Core |
$14.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.36
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$46.36
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.83
|
| Rate for Payer: BCN Commercial |
$35.83
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.41
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
IP
|
$232.75
|
|
|
Service Code
|
NDC 6498010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.95 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: BCBS Trust/PPO |
$179.87
|
| Rate for Payer: BCN Commercial |
$179.87
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.82
|
| Rate for Payer: UHC Core |
$194.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
IP
|
$131.91
|
|
|
Service Code
|
NDC 6808476425
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.45 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Aetna Commercial |
$112.12
|
| Rate for Payer: BCBS Trust/PPO |
$101.94
|
| Rate for Payer: BCN Commercial |
$101.94
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cofinity Commercial |
$113.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.53
|
| Rate for Payer: Healthscope Commercial |
$118.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.12
|
| Rate for Payer: PHP Commercial |
$112.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.08
|
| Rate for Payer: UHC Core |
$110.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.93
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 6808476495
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.74
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
IP
|
$131.61
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.27 |
| Max. Negotiated Rate |
$118.45 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: BCBS Trust/PPO |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$101.71
|
| Rate for Payer: BCN Commercial |
$101.71
|
| Rate for Payer: BCN Commercial |
$24.76
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.23
|
| Rate for Payer: PHP Commercial |
$111.87
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.82
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: UHC Core |
$26.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.03
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
IP
|
$149.23
|
|
|
Service Code
|
NDC 8065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Aetna Commercial |
$126.85
|
| Rate for Payer: BCBS Trust/PPO |
$115.32
|
| Rate for Payer: BCN Commercial |
$115.32
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$128.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$134.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.85
|
| Rate for Payer: PHP Commercial |
$126.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.32
|
| Rate for Payer: UHC Core |
$124.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.92
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$47.93
|
|
|
Service Code
|
NDC 70069-261-01
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$37.04
|
| Rate for Payer: BCN Commercial |
$37.04
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cofinity Commercial |
$41.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.34
|
| Rate for Payer: Healthscope Commercial |
$43.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.74
|
| Rate for Payer: PHP Commercial |
$40.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.18
|
| Rate for Payer: UHC Core |
$40.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$430.62
|
|
|
Service Code
|
NDC 25021-310-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$387.56 |
| Rate for Payer: Aetna Commercial |
$366.03
|
| Rate for Payer: BCBS Trust/PPO |
$332.78
|
| Rate for Payer: BCN Commercial |
$332.78
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cofinity Commercial |
$370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.50
|
| Rate for Payer: Healthscope Commercial |
$387.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.03
|
| Rate for Payer: PHP Commercial |
$366.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.95
|
| Rate for Payer: UHC Core |
$359.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.96
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$51.76
|
|
|
Service Code
|
NDC 70121-1189-1
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$40.00
|
| Rate for Payer: BCN Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.41
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.00
|
| Rate for Payer: PHP Commercial |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.55
|
| Rate for Payer: UHC Core |
$43.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.82
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$84.55
|
|
|
Service Code
|
NDC 25021-310-66
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.57 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: BCBS Trust/PPO |
$65.34
|
| Rate for Payer: BCN Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.87
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$231.11
|
|
|
Service Code
|
NDC 14789-012-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.95 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: BCBS Trust/PPO |
$178.60
|
| Rate for Payer: BCN Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.44
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.38
|
| Rate for Payer: UHC Core |
$192.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.33
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-72
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$221.79 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: BCBS Trust/PPO |
$190.44
|
| Rate for Payer: BCN Commercial |
$190.44
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$221.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: PHP Commercial |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.86
|
| Rate for Payer: UHC Core |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.82
|
|
