|
DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$65.20
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
112012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna Commercial |
$58.68
|
| Rate for Payer: ASR ASR |
$63.24
|
| Rate for Payer: ASR Commercial |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$53.13
|
| 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: UHC All Payor (Choice/PPO) + Core |
$57.38
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$110.51
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.83 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$99.46
|
| Rate for Payer: ASR ASR |
$107.19
|
| Rate for Payer: ASR Commercial |
$107.19
|
| Rate for Payer: BCBS Trust/PPO |
$90.05
|
| Rate for Payer: BCN Commercial |
$85.68
|
| Rate for Payer: Cash Price |
$88.41
|
| Rate for Payer: Cofinity Commercial |
$103.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.41
|
| Rate for Payer: Healthscope Commercial |
$110.51
|
| Rate for Payer: Healthscope Whirlpool |
$107.19
|
| Rate for Payer: Mclaren Commercial |
$99.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.93
|
| Rate for Payer: Nomi Health Commercial |
$90.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.25
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$98.68
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.14 |
| Max. Negotiated Rate |
$98.68 |
| Rate for Payer: Aetna Commercial |
$88.81
|
| Rate for Payer: ASR ASR |
$95.72
|
| Rate for Payer: ASR Commercial |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.41
|
| Rate for Payer: BCN Commercial |
$76.51
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$92.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.94
|
| Rate for Payer: Healthscope Commercial |
$98.68
|
| Rate for Payer: Healthscope Whirlpool |
$95.72
|
| Rate for Payer: Mclaren Commercial |
$88.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Nomi Health Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.84
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$98.68
|
|
|
Service Code
|
NDC 76329330101
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$98.68 |
| Rate for Payer: Aetna Commercial |
$88.81
|
| Rate for Payer: Aetna Medicare |
$49.34
|
| Rate for Payer: ASR ASR |
$95.72
|
| Rate for Payer: ASR Commercial |
$95.72
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Trust/PPO |
$80.81
|
| Rate for Payer: BCN Commercial |
$76.51
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$92.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.94
|
| Rate for Payer: Healthscope Commercial |
$98.68
|
| Rate for Payer: Healthscope Whirlpool |
$95.72
|
| Rate for Payer: Mclaren Commercial |
$88.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Nomi Health Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.46
|
| Rate for Payer: Priority Health Narrow Network |
$69.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.84
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$107.80
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Aetna Medicare |
$53.90
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: ASR Commercial |
$104.57
|
| Rate for Payer: BCBS Complete |
$43.12
|
| Rate for Payer: BCBS Trust/PPO |
$88.28
|
| Rate for Payer: BCN Commercial |
$83.58
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Commercial |
$101.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$107.80
|
| Rate for Payer: Healthscope Whirlpool |
$104.57
|
| Rate for Payer: Mclaren Commercial |
$97.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.45
|
| Rate for Payer: Priority Health Narrow Network |
$75.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.86
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
OP
|
$110.51
|
|
|
Service Code
|
NDC 00409490234
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna Commercial |
$99.46
|
| Rate for Payer: Aetna Medicare |
$55.26
|
| Rate for Payer: ASR ASR |
$107.19
|
| Rate for Payer: ASR Commercial |
$107.19
|
| Rate for Payer: BCBS Complete |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.50
|
| Rate for Payer: BCN Commercial |
$85.68
|
| Rate for Payer: Cash Price |
$88.41
|
| Rate for Payer: Cofinity Commercial |
$103.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.41
|
| Rate for Payer: Healthscope Commercial |
$110.51
|
| Rate for Payer: Healthscope Whirlpool |
$107.19
|
| Rate for Payer: Mclaren Commercial |
$99.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.93
|
| Rate for Payer: Nomi Health Commercial |
$90.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.83
|
| Rate for Payer: Priority Health Narrow Network |
$77.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.25
|
|
|
DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)
|
Facility
|
IP
|
$107.80
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
163718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$107.80 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: ASR ASR |
$104.57
|
| Rate for Payer: ASR Commercial |
$104.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.85
|
| Rate for Payer: BCN Commercial |
$83.58
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Commercial |
$101.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$107.80
|
| Rate for Payer: Healthscope Whirlpool |
$104.57
|
| Rate for Payer: Mclaren Commercial |
$97.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.86
|
|
|
DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
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 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008504
|
| Hospital Charge Code |
9814
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
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 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338008904
|
| Hospital Charge Code |
9815
|
|
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 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
9788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| 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: 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 |
$8.14
|
| Rate for Payer: Priority Health Narrow Network |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7121
|
| Hospital Charge Code |
9788
|
|
Hospital Revenue Code
|
636
|
| 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 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$183.12
|
|
|
Service Code
|
NDC 00338055111
|
| Hospital Charge Code |
116171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$183.12 |
| Rate for Payer: Aetna Commercial |
$164.81
|
| Rate for Payer: Aetna Medicare |
$91.56
|
| Rate for Payer: ASR ASR |
$177.63
|
| Rate for Payer: ASR Commercial |
$177.63
|
| Rate for Payer: BCBS Complete |
$73.25
|
| Rate for Payer: BCBS Trust/PPO |
$149.96
|
| Rate for Payer: BCN Commercial |
$141.97
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$172.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.50
|
| Rate for Payer: Healthscope Commercial |
$183.12
|
| Rate for Payer: Healthscope Whirlpool |
$177.63
|
| Rate for Payer: Mclaren Commercial |
$164.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.65
|
| Rate for Payer: Nomi Health Commercial |
$150.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.45
|
| Rate for Payer: Priority Health Narrow Network |
$128.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.15
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$183.12
|
|
|
Service Code
|
NDC 00338055111
|
| Hospital Charge Code |
116171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$183.12 |
| Rate for Payer: Aetna Commercial |
$164.81
|
| Rate for Payer: ASR ASR |
$177.63
|
| Rate for Payer: ASR Commercial |
$177.63
|
| Rate for Payer: BCBS Trust/PPO |
$149.22
|
| Rate for Payer: BCN Commercial |
$141.97
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$172.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.50
|
| Rate for Payer: Healthscope Commercial |
$183.12
|
| Rate for Payer: Healthscope Whirlpool |
$177.63
|
| Rate for Payer: Mclaren Commercial |
$164.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.65
|
| Rate for Payer: Nomi Health Commercial |
$150.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.15
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| 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 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: ASR ASR |
$69.63
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: ASR Commercial |
$52.14
|
| Rate for Payer: ASR Commercial |
$69.63
|
| Rate for Payer: ASR Commercial |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$45.63
|
| Rate for Payer: BCBS Trust/PPO |
$43.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.49
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: BCN Commercial |
$55.65
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$69.63
|
| Rate for Payer: Mclaren Commercial |
$64.60
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Nomi Health Commercial |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.02 |
| 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: 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 |
$3.78
|
| Rate for Payer: Priority Health Narrow Network |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
2364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: ASR ASR |
$69.63
|
| Rate for Payer: ASR Commercial |
$54.31
|
| Rate for Payer: ASR Commercial |
$52.14
|
| Rate for Payer: ASR Commercial |
$69.63
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Trust/PPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$44.02
|
| Rate for Payer: BCBS Trust/PPO |
$45.85
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: BCN Commercial |
$55.65
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$69.63
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Mclaren Commercial |
$64.60
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$44.08
|
| Rate for Payer: Nomi Health Commercial |
$58.86
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.17
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$71.78
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$27.92
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: ASR ASR |
$54.16
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$69.63
|
| Rate for Payer: ASR Commercial |
$54.16
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$69.63
|
| Rate for Payer: ASR Commercial |
$54.31
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS Complete |
$22.33
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$45.72
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: BCN Commercial |
$55.65
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$54.16
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$69.63
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$64.60
|
| Rate for Payer: Mclaren Commercial |
$50.25
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$58.86
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: ASR ASR |
$54.16
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: ASR ASR |
$69.63
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$69.63
|
| Rate for Payer: ASR Commercial |
$54.31
|
| Rate for Payer: ASR Commercial |
$54.16
|
| Rate for Payer: BCBS Trust/PPO |
$58.49
|
| Rate for Payer: BCBS Trust/PPO |
$45.50
|
| Rate for Payer: BCBS Trust/PPO |
$45.63
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$55.65
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Whirlpool |
$69.63
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$54.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$64.60
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Mclaren Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Nomi Health Commercial |
$45.78
|
| Rate for Payer: Nomi Health Commercial |
$58.86
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.02 |
| 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: 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 |
$3.78
|
| Rate for Payer: Priority Health Narrow Network |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 5 % IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
400293
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
DIATRIZOATE MEGLUMINE 30 % URETHRAL SOLUTION
|
Facility
|
OP
|
$79.20
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
27735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$71.28
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: ASR ASR |
$76.82
|
| Rate for Payer: ASR Commercial |
$76.82
|
| Rate for Payer: BCBS Complete |
$31.68
|
| Rate for Payer: BCBS Trust/PPO |
$64.86
|
| Rate for Payer: BCN Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$74.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.36
|
| Rate for Payer: Healthscope Commercial |
$79.20
|
| Rate for Payer: Healthscope Whirlpool |
$76.82
|
| Rate for Payer: Mclaren Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.32
|
| Rate for Payer: Nomi Health Commercial |
$64.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.40
|
| Rate for Payer: Priority Health Narrow Network |
$55.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.70
|
|
|
DIATRIZOATE MEGLUMINE 30 % URETHRAL SOLUTION
|
Facility
|
IP
|
$79.20
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
27735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$71.28
|
| Rate for Payer: ASR ASR |
$76.82
|
| Rate for Payer: ASR Commercial |
$76.82
|
| Rate for Payer: BCBS Trust/PPO |
$64.54
|
| Rate for Payer: BCN Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$74.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.36
|
| Rate for Payer: Healthscope Commercial |
$79.20
|
| Rate for Payer: Healthscope Whirlpool |
$76.82
|
| Rate for Payer: Mclaren Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.32
|
| Rate for Payer: Nomi Health Commercial |
$64.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.70
|
|
