|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$7.54
|
|
|
Service Code
|
NDC 00121127610
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: ASR ASR |
$7.31
|
| Rate for Payer: ASR Commercial |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$7.54
|
| Rate for Payer: Healthscope Whirlpool |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.64
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$7.54
|
|
|
Service Code
|
NDC 00121127600
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Medicare |
$3.77
|
| Rate for Payer: ASR ASR |
$7.31
|
| Rate for Payer: ASR Commercial |
$7.31
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$7.54
|
| Rate for Payer: Healthscope Whirlpool |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.61
|
| Rate for Payer: Priority Health Narrow Network |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.64
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$6.79
|
|
|
Service Code
|
NDC 00121063805
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Aetna Commercial |
$6.11
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: ASR ASR |
$6.59
|
| Rate for Payer: ASR Commercial |
$6.59
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS Trust/PPO |
$5.56
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.43
|
| Rate for Payer: Healthscope Commercial |
$6.79
|
| Rate for Payer: Healthscope Whirlpool |
$6.59
|
| Rate for Payer: Mclaren Commercial |
$6.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.77
|
| Rate for Payer: Nomi Health Commercial |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.95
|
| Rate for Payer: Priority Health Narrow Network |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.98
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$6.79
|
|
|
Service Code
|
NDC 00121063805
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Aetna Commercial |
$6.11
|
| Rate for Payer: ASR ASR |
$6.59
|
| Rate for Payer: ASR Commercial |
$6.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.43
|
| Rate for Payer: Healthscope Commercial |
$6.79
|
| Rate for Payer: Healthscope Whirlpool |
$6.59
|
| Rate for Payer: Mclaren Commercial |
$6.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.77
|
| Rate for Payer: Nomi Health Commercial |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.98
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: ASR Commercial |
$61.89
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna Commercial |
$55.06
|
| Rate for Payer: Aetna Medicare |
$30.59
|
| Rate for Payer: ASR ASR |
$59.34
|
| Rate for Payer: ASR Commercial |
$59.34
|
| Rate for Payer: BCBS Complete |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$50.10
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$61.18
|
| Rate for Payer: Healthscope Whirlpool |
$59.34
|
| Rate for Payer: Mclaren Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.61
|
| Rate for Payer: Priority Health Narrow Network |
$42.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.84
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$61.18
|
|
|
Service Code
|
NDC 00338002302
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.77 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna Commercial |
$55.06
|
| Rate for Payer: ASR ASR |
$59.34
|
| Rate for Payer: ASR Commercial |
$59.34
|
| Rate for Payer: BCBS Trust/PPO |
$49.86
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$57.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$61.18
|
| Rate for Payer: Healthscope Whirlpool |
$59.34
|
| Rate for Payer: Mclaren Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$50.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.84
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: ASR Commercial |
$61.89
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$52.25
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.90
|
| Rate for Payer: Priority Health Narrow Network |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338002304
|
| Hospital Charge Code |
300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: ASR Commercial |
$61.89
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
DEXTROSE 10 % IV BOLUS
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
NDC 00264752020
|
| Hospital Charge Code |
400302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: ASR Commercial |
$61.89
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$52.25
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.90
|
| Rate for Payer: Priority Health Narrow Network |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
DEXTROSE 15 GRAM/32 ML ORAL GEL PACKET
|
Facility
|
OP
|
$42.98
|
|
|
Service Code
|
NDC 21292000441
|
| Hospital Charge Code |
185468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$21.49
|
| Rate for Payer: ASR ASR |
$41.69
|
| Rate for Payer: ASR Commercial |
$41.69
|
| Rate for Payer: BCBS Complete |
$17.19
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$33.32
|
| Rate for Payer: Cash Price |
$34.38
|
| Rate for Payer: Cofinity Commercial |
$40.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.38
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Healthscope Whirlpool |
$41.69
|
| Rate for Payer: Mclaren Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.53
|
| Rate for Payer: Nomi Health Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.66
|
| Rate for Payer: Priority Health Narrow Network |
$30.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.82
|
|
|
DEXTROSE 15 GRAM/32 ML ORAL GEL PACKET
|
Facility
|
IP
|
$42.98
|
|
|
Service Code
|
NDC 21292000441
|
| Hospital Charge Code |
185468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: ASR ASR |
$41.69
|
| Rate for Payer: ASR Commercial |
$41.69
|
| Rate for Payer: BCBS Trust/PPO |
$35.02
|
| Rate for Payer: BCN Commercial |
$33.32
|
| Rate for Payer: Cash Price |
$34.38
|
| Rate for Payer: Cofinity Commercial |
$40.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.38
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Healthscope Whirlpool |
$41.69
|
| Rate for Payer: Mclaren Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.53
|
| Rate for Payer: Nomi Health Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.82
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.92
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.57 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$66.53
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: ASR ASR |
$71.70
|
| Rate for Payer: ASR Commercial |
$71.70
|
| Rate for Payer: BCBS Complete |
$29.57
|
| Rate for Payer: BCBS Trust/PPO |
$60.53
|
| Rate for Payer: BCN Commercial |
$57.31
|
| Rate for Payer: Cash Price |
$59.13
|
| Rate for Payer: Cofinity Commercial |
$69.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.14
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Healthscope Whirlpool |
$71.70
|
| Rate for Payer: Mclaren Commercial |
$66.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.83
|
| Rate for Payer: Nomi Health Commercial |
$60.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.77
|
| Rate for Payer: Priority Health Narrow Network |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.05
|
|
|
DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.92
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
2361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$66.53
|
| Rate for Payer: ASR ASR |
$71.70
|
| Rate for Payer: ASR Commercial |
$71.70
|
| Rate for Payer: BCBS Trust/PPO |
$60.24
|
| Rate for Payer: BCN Commercial |
$57.31
|
| Rate for Payer: Cash Price |
$59.13
|
| Rate for Payer: Cofinity Commercial |
$69.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.14
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Healthscope Whirlpool |
$71.70
|
| Rate for Payer: Mclaren Commercial |
$66.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.83
|
| Rate for Payer: Nomi Health Commercial |
$60.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.05
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$68.58
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$68.58 |
| Rate for Payer: Aetna Commercial |
$61.72
|
| Rate for Payer: Aetna Medicare |
$34.29
|
| Rate for Payer: ASR ASR |
$66.52
|
| Rate for Payer: ASR Commercial |
$66.52
|
| Rate for Payer: BCBS Complete |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$56.16
|
| Rate for Payer: BCN Commercial |
$53.17
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.86
|
| Rate for Payer: Healthscope Commercial |
$68.58
|
| Rate for Payer: Healthscope Whirlpool |
$66.52
|
| Rate for Payer: Mclaren Commercial |
$61.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.29
|
| Rate for Payer: Nomi Health Commercial |
$56.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.09
|
| Rate for Payer: Priority Health Narrow Network |
$48.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.35
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$68.58
|
|
|
Service Code
|
NDC 00409664802
|
| Hospital Charge Code |
2365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$68.58 |
| Rate for Payer: Aetna Commercial |
$61.72
|
| Rate for Payer: ASR ASR |
$66.52
|
| Rate for Payer: ASR Commercial |
$66.52
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Commercial |
$53.17
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.86
|
| Rate for Payer: Healthscope Commercial |
$68.58
|
| Rate for Payer: Healthscope Whirlpool |
$66.52
|
| Rate for Payer: Mclaren Commercial |
$61.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.29
|
| Rate for Payer: Nomi Health Commercial |
$56.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.35
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$63.60
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$57.24
|
| Rate for Payer: ASR ASR |
$61.69
|
| Rate for Payer: ASR Commercial |
$61.69
|
| Rate for Payer: BCBS Trust/PPO |
$51.83
|
| Rate for Payer: BCN Commercial |
$49.31
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$59.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$63.60
|
| Rate for Payer: Healthscope Whirlpool |
$61.69
|
| Rate for Payer: Mclaren Commercial |
$57.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.97
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: ASR ASR |
$41.71
|
| Rate for Payer: ASR Commercial |
$41.71
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.21
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$43.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.71
|
| Rate for Payer: Mclaren Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.68
|
| Rate for Payer: Priority Health Narrow Network |
$30.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.84
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$65.20
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna Commercial |
$58.68
|
| Rate for Payer: Aetna Medicare |
$32.60
|
| Rate for Payer: ASR ASR |
$63.24
|
| Rate for Payer: ASR Commercial |
$63.24
|
| Rate for Payer: BCBS Complete |
$26.08
|
| Rate for Payer: BCBS Trust/PPO |
$53.39
|
| Rate for Payer: BCN Commercial |
$50.55
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cofinity Commercial |
$61.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Whirlpool |
$63.24
|
| Rate for Payer: Mclaren Commercial |
$58.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.13
|
| Rate for Payer: Priority Health Narrow Network |
$45.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.38
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: ASR ASR |
$41.71
|
| Rate for Payer: ASR Commercial |
$41.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.04
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$43.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.71
|
| Rate for Payer: Mclaren Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.84
|
|
|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$63.60
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$57.24
|
| Rate for Payer: Aetna Medicare |
$31.80
|
| Rate for Payer: ASR ASR |
$61.69
|
| Rate for Payer: ASR Commercial |
$61.69
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$49.31
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$59.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$63.60
|
| Rate for Payer: Healthscope Whirlpool |
$61.69
|
| Rate for Payer: Mclaren Commercial |
$57.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.73
|
| Rate for Payer: Priority Health Narrow Network |
$44.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.97
|
|
