|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$100.20
|
|
|
Service Code
|
NDC 45802-868-66
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$100.20 |
| Rate for Payer: Aetna Commercial |
$90.18
|
| Rate for Payer: ASR ASR |
$97.19
|
| Rate for Payer: BCBS Trust/PPO |
$77.69
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: Cash Price |
$80.16
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.16
|
| Rate for Payer: Healthscope Commercial |
$100.20
|
| Rate for Payer: Healthscope Whirlpool |
$97.19
|
| Rate for Payer: Mclaren Commercial |
$90.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.18
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.49
|
|
|
Service Code
|
NDC 0904-6931-86
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$5.84
|
| Rate for Payer: ASR ASR |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$5.03
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.19
|
| Rate for Payer: Healthscope Commercial |
$6.49
|
| Rate for Payer: Healthscope Whirlpool |
$6.30
|
| Rate for Payer: Mclaren Commercial |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.71
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$69.89
|
|
|
Service Code
|
NDC 68084-430-98
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: BCBS Trust/PPO |
$54.19
|
| Rate for Payer: BCN Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.79
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
NDC 51079-306-01
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna Commercial |
$6.05
|
| Rate for Payer: ASR ASR |
$6.52
|
| Rate for Payer: BCBS Trust/PPO |
$5.21
|
| Rate for Payer: BCN Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Commercial |
$6.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.72
|
| Rate for Payer: Healthscope Whirlpool |
$6.52
|
| Rate for Payer: Mclaren Commercial |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.91
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$691.20
|
|
|
Service Code
|
NDC 17856-0312-1
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.84 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$622.08
|
| Rate for Payer: ASR ASR |
$670.46
|
| Rate for Payer: BCBS Trust/PPO |
$535.89
|
| Rate for Payer: BCN Commercial |
$535.89
|
| Rate for Payer: Cash Price |
$552.96
|
| Rate for Payer: Cofinity Commercial |
$649.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.96
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Healthscope Whirlpool |
$670.46
|
| Rate for Payer: Mclaren Commercial |
$622.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.26
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$23,651.28
|
|
|
Service Code
|
MS-DRG 862
|
| Min. Negotiated Rate |
$16,412.24 |
| Max. Negotiated Rate |
$23,651.28 |
| Rate for Payer: Aetna Medicare |
$17,276.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,595.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,595.05
|
| Rate for Payer: BCBS MAPPO |
$17,276.04
|
| Rate for Payer: BCN Medicare Advantage |
$17,276.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,276.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,276.04
|
| Rate for Payer: Mclaren Medicare |
$17,276.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,139.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,867.45
|
| Rate for Payer: PACE Medicare |
$16,412.24
|
| Rate for Payer: PACE SWMI |
$17,276.04
|
| Rate for Payer: PHP Commercial |
$19,003.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,276.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,651.28
|
| Rate for Payer: Priority Health Medicare |
$17,276.04
|
| Rate for Payer: Priority Health Narrow Network |
$18,921.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17,276.04
|
| Rate for Payer: UHC Medicare Advantage |
$17,794.32
|
| Rate for Payer: VA VA |
$17,276.04
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$12,910.62
|
|
|
Service Code
|
MS-DRG 863
|
| Min. Negotiated Rate |
$9,684.20 |
| Max. Negotiated Rate |
$12,910.62 |
| Rate for Payer: Aetna Medicare |
$10,193.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,742.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,742.38
|
| Rate for Payer: BCBS MAPPO |
$10,193.90
|
| Rate for Payer: BCN Medicare Advantage |
$10,193.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,193.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,193.90
|
| Rate for Payer: Mclaren Medicare |
$10,193.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,703.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,722.98
|
| Rate for Payer: PACE Medicare |
$9,684.20
|
| Rate for Payer: PACE SWMI |
$10,193.90
|
| Rate for Payer: PHP Commercial |
$11,213.29
|
| Rate for Payer: PHP Medicare Advantage |
$10,193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,910.62
|
| Rate for Payer: Priority Health Medicare |
$10,193.90
|
| Rate for Payer: Priority Health Narrow Network |
$10,328.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10,193.90
|
| Rate for Payer: UHC Medicare Advantage |
$10,499.72
|
| Rate for Payer: VA VA |
$10,193.90
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$27,422.39
|
|
|
Service Code
|
MS-DRG 857
|
| Min. Negotiated Rate |
$18,774.50 |
| Max. Negotiated Rate |
$27,422.39 |
| Rate for Payer: Aetna Medicare |
$19,762.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,703.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,703.29
|
| Rate for Payer: BCBS MAPPO |
$19,762.63
|
| Rate for Payer: BCN Medicare Advantage |
$19,762.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,762.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,762.63
|
| Rate for Payer: Mclaren Medicare |
$19,762.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,750.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,727.02
|
| Rate for Payer: PACE Medicare |
$18,774.50
|
| Rate for Payer: PACE SWMI |
$19,762.63
|
| Rate for Payer: PHP Commercial |
$21,738.89
|
| Rate for Payer: PHP Medicare Advantage |
$19,762.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,422.39
|
| Rate for Payer: Priority Health Medicare |
$19,762.63
|
| Rate for Payer: Priority Health Narrow Network |
$21,937.91
|
| Rate for Payer: Railroad Medicare Medicare |
$19,762.63
|
| Rate for Payer: UHC Medicare Advantage |
$20,355.51
|
| Rate for Payer: VA VA |
$19,762.63
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$56,860.66
|
|
|
Service Code
|
MS-DRG 856
|
| Min. Negotiated Rate |
$37,214.85 |
| Max. Negotiated Rate |
$56,860.66 |
| Rate for Payer: Aetna Medicare |
$39,173.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,966.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,966.91
|
| Rate for Payer: BCBS MAPPO |
$39,173.53
|
| Rate for Payer: BCN Medicare Advantage |
$39,173.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,173.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,173.53
|
| Rate for Payer: Mclaren Medicare |
$39,173.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,132.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,049.56
|
| Rate for Payer: PACE Medicare |
$37,214.85
|
| Rate for Payer: PACE SWMI |
$39,173.53
|
| Rate for Payer: PHP Commercial |
$43,090.88
|
| Rate for Payer: PHP Medicare Advantage |
$39,173.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,860.66
|
| Rate for Payer: Priority Health Medicare |
$39,173.53
|
| Rate for Payer: Priority Health Narrow Network |
$45,488.53
|
| Rate for Payer: Railroad Medicare Medicare |
$39,173.53
|
| Rate for Payer: UHC Medicare Advantage |
$40,348.74
|
| Rate for Payer: VA VA |
$39,173.53
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,478.86
|
|
|
Service Code
|
MS-DRG 858
|
| Min. Negotiated Rate |
$11,919.37 |
| Max. Negotiated Rate |
$16,478.86 |
| Rate for Payer: Aetna Medicare |
$12,546.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,683.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,683.39
|
| Rate for Payer: BCBS MAPPO |
$12,546.71
|
| Rate for Payer: BCN Medicare Advantage |
$12,546.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,546.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,546.71
|
| Rate for Payer: Mclaren Medicare |
$12,546.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,174.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,428.72
|
| Rate for Payer: PACE Medicare |
$11,919.37
|
| Rate for Payer: PACE SWMI |
$12,546.71
|
| Rate for Payer: PHP Commercial |
$13,801.38
|
| Rate for Payer: PHP Medicare Advantage |
$12,546.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,478.86
|
| Rate for Payer: Priority Health Medicare |
$12,546.71
|
| Rate for Payer: Priority Health Narrow Network |
$13,183.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12,546.71
|
| Rate for Payer: UHC Medicare Advantage |
$12,923.11
|
| Rate for Payer: VA VA |
$12,546.71
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$19,823.68
|
|
|
Service Code
|
MS-DRG 769
|
| Min. Negotiated Rate |
$14,014.60 |
| Max. Negotiated Rate |
$19,823.68 |
| Rate for Payer: Aetna Medicare |
$14,752.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,440.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,440.26
|
| Rate for Payer: BCBS MAPPO |
$14,752.21
|
| Rate for Payer: BCN Medicare Advantage |
$14,752.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,752.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,752.21
|
| Rate for Payer: Mclaren Medicare |
$14,752.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,489.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,965.04
|
| Rate for Payer: PACE Medicare |
$14,014.60
|
| Rate for Payer: PACE SWMI |
$14,752.21
|
| Rate for Payer: PHP Commercial |
$16,227.43
|
| Rate for Payer: PHP Medicare Advantage |
$14,752.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,823.68
|
| Rate for Payer: Priority Health Medicare |
$14,752.21
|
| Rate for Payer: Priority Health Narrow Network |
$15,858.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14,752.21
|
| Rate for Payer: UHC Medicare Advantage |
$15,194.78
|
| Rate for Payer: VA VA |
$14,752.21
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$9,686.01
|
|
|
Service Code
|
MS-DRG 776
|
| Min. Negotiated Rate |
$7,361.37 |
| Max. Negotiated Rate |
$9,686.01 |
| Rate for Payer: Aetna Medicare |
$7,748.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,686.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,686.01
|
| Rate for Payer: BCBS MAPPO |
$7,748.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,748.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,748.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,748.81
|
| Rate for Payer: Mclaren Medicare |
$7,748.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,136.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,911.13
|
| Rate for Payer: PACE Medicare |
$7,361.37
|
| Rate for Payer: PACE SWMI |
$7,748.81
|
| Rate for Payer: PHP Commercial |
$8,523.69
|
| Rate for Payer: PHP Medicare Advantage |
$7,748.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,202.43
|
| Rate for Payer: Priority Health Medicare |
$7,748.81
|
| Rate for Payer: Priority Health Narrow Network |
$7,361.94
|
| Rate for Payer: Railroad Medicare Medicare |
$7,748.81
|
| Rate for Payer: UHC Medicare Advantage |
$7,981.27
|
| Rate for Payer: VA VA |
$7,748.81
|
|
|
POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: ASR ASR |
$28.13
|
| Rate for Payer: BCBS Trust/PPO |
$22.48
|
| Rate for Payer: BCN Commercial |
$22.48
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$29.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Mclaren Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.52
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.29 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial |
$72.37
|
| Rate for Payer: ASR ASR |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$62.34
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$75.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Healthscope Whirlpool |
$78.00
|
| Rate for Payer: Mclaren Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.76
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689-047-30
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$15.92
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$20.54
|
| Rate for Payer: Healthscope Whirlpool |
$19.92
|
| Rate for Payer: Mclaren Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
NDC 0121-4948-00
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.29
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
NDC 0904-7061-88
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna Commercial |
$17.04
|
| Rate for Payer: ASR ASR |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$17.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Healthscope Whirlpool |
$18.36
|
| Rate for Payer: Mclaren Commercial |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.66
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689-047-01
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$15.92
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$20.54
|
| Rate for Payer: Healthscope Whirlpool |
$19.92
|
| Rate for Payer: Mclaren Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
NDC 0121-4948-15
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.29
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
NDC 0904-7061-87
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Aetna Commercial |
$21.78
|
| Rate for Payer: ASR ASR |
$23.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$24.20
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Mclaren Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.30
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 0264-7652-00
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$95.70 |
| Rate for Payer: Aetna Commercial |
$86.13
|
| Rate for Payer: ASR ASR |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$74.20
|
| Rate for Payer: BCN Commercial |
$74.20
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$89.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$95.70
|
| Rate for Payer: Healthscope Whirlpool |
$92.83
|
| Rate for Payer: Mclaren Commercial |
$86.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.22
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0803-04
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| 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 Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.9% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0803-04
|
| Hospital Charge Code |
300207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
