|
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 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
|
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 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 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
|
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
|
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
|
|
|
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) 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
|
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) 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
|
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
|
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 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
|
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
|
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 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
|
|
