|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0671-04
|
| Hospital Charge Code |
9801
|
|
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 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.27
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Aetna Commercial |
$16.44
|
| Rate for Payer: Aetna Commercial |
$18.82
|
| Rate for Payer: ASR ASR |
$17.72
|
| Rate for Payer: ASR ASR |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.21
|
| Rate for Payer: BCN Commercial |
$16.21
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.73
|
| Rate for Payer: Healthscope Commercial |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$18.27
|
| Rate for Payer: Healthscope Whirlpool |
$17.72
|
| Rate for Payer: Healthscope Whirlpool |
$20.28
|
| Rate for Payer: Mclaren Commercial |
$18.82
|
| Rate for Payer: Mclaren Commercial |
$16.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.40
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0695-04
|
| Hospital Charge Code |
11082
|
|
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 ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687-466-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$234.98
|
| Rate for Payer: BCBS Trust/PPO |
$187.82
|
| Rate for Payer: BCN Commercial |
$187.82
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cofinity Commercial |
$227.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$242.25
|
| Rate for Payer: Healthscope Whirlpool |
$234.98
|
| Rate for Payer: Mclaren Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.18
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 0904-7216-61
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Trust/PPO |
$167.19
|
| Rate for Payer: BCN Commercial |
$167.19
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$215.65
|
| Rate for Payer: Healthscope Whirlpool |
$209.18
|
| Rate for Payer: Mclaren Commercial |
$194.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 0574-0275-00
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: ASR ASR |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.37
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 0832-5323-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: BCBS Trust/PPO |
$202.24
|
| Rate for Payer: BCN Commercial |
$202.24
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$260.85
|
| Rate for Payer: Healthscope Whirlpool |
$253.02
|
| Rate for Payer: Mclaren Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 0574-0275-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.96
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: BCBS Trust/PPO |
$208.44
|
| Rate for Payer: BCN Commercial |
$208.44
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$252.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$268.85
|
| Rate for Payer: Healthscope Whirlpool |
$260.78
|
| Rate for Payer: Mclaren Commercial |
$241.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 60687-466-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Mclaren Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 0781-1526-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.63 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: BCBS Trust/PPO |
$310.82
|
| Rate for Payer: BCN Commercial |
$310.82
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$376.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Healthscope Whirlpool |
$388.87
|
| Rate for Payer: Mclaren Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$237.50
|
|
|
Service Code
|
NDC 60687-697-01
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: ASR ASR |
$230.38
|
| Rate for Payer: BCBS Trust/PPO |
$184.13
|
| Rate for Payer: BCN Commercial |
$184.13
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$223.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$237.50
|
| Rate for Payer: Healthscope Whirlpool |
$230.38
|
| Rate for Payer: Mclaren Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.00
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 60687-697-11
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: ASR ASR |
$2.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.85
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Healthscope Whirlpool |
$2.31
|
| Rate for Payer: Mclaren Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.09
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$469.30
|
|
|
Service Code
|
NDC 0486-1111-01
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.51 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$422.37
|
| Rate for Payer: ASR ASR |
$455.22
|
| Rate for Payer: BCBS Trust/PPO |
$363.85
|
| Rate for Payer: BCN Commercial |
$363.85
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Commercial |
$441.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$469.30
|
| Rate for Payer: Healthscope Whirlpool |
$455.22
|
| Rate for Payer: Mclaren Commercial |
$422.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.98
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 3932800810
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.21 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Aetna Commercial |
$405.27
|
| Rate for Payer: ASR ASR |
$436.79
|
| Rate for Payer: BCBS Trust/PPO |
$349.12
|
| Rate for Payer: BCN Commercial |
$349.12
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$423.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$450.30
|
| Rate for Payer: Healthscope Whirlpool |
$436.79
|
| Rate for Payer: Mclaren Commercial |
$405.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.26
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$77.85
|
|
|
Service Code
|
NDC 63323-086-05
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: ASR ASR |
$75.51
|
| Rate for Payer: BCBS Trust/PPO |
$60.36
|
| Rate for Payer: BCN Commercial |
$60.36
|
| Rate for Payer: Cash Price |
$62.28
|
| Rate for Payer: Cofinity Commercial |
$73.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.28
|
| Rate for Payer: Healthscope Commercial |
$77.85
|
| Rate for Payer: Healthscope Whirlpool |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$70.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.51
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.62
|
|
|
Service Code
|
NDC 0409-7295-01
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: ASR ASR |
$181.02
|
| Rate for Payer: BCBS Trust/PPO |
$144.69
|
| Rate for Payer: BCN Commercial |
$144.69
|
| Rate for Payer: Cash Price |
$149.29
|
| Rate for Payer: Cofinity Commercial |
$175.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.30
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Healthscope Whirlpool |
$181.02
|
| Rate for Payer: Mclaren Commercial |
$167.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.23
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323-086-15
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$287.45 |
| Max. Negotiated Rate |
$410.64 |
| Rate for Payer: Aetna Commercial |
$369.58
|
| Rate for Payer: ASR ASR |
$398.32
|
| Rate for Payer: BCBS Trust/PPO |
$318.37
|
| Rate for Payer: BCN Commercial |
$318.37
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$386.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$410.64
|
| Rate for Payer: Healthscope Whirlpool |
$398.32
|
| Rate for Payer: Mclaren Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.36
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.62
|
|
|
Service Code
|
NDC 0409-7295-11
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: ASR ASR |
$181.02
|
| Rate for Payer: BCBS Trust/PPO |
$144.69
|
| Rate for Payer: BCN Commercial |
$144.69
|
| Rate for Payer: Cash Price |
$149.29
|
| Rate for Payer: Cofinity Commercial |
$175.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.30
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Healthscope Whirlpool |
$181.02
|
| Rate for Payer: Mclaren Commercial |
$167.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.23
|
|
|
PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$2,967.99 |
| Rate for Payer: Aetna Commercial |
$1,320.28
|
| Rate for Payer: Aetna Medicare |
$985.28
|
| Rate for Payer: BCBS Complete |
$672.97
|
| Rate for Payer: BCBS MAPPO |
$985.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,967.99
|
| Rate for Payer: BCN Commercial |
$1,452.84
|
| Rate for Payer: BCN Medicare Advantage |
$985.28
|
| Rate for Payer: Cash Price |
$1,645.60
|
| Rate for Payer: Cash Price |
$1,645.60
|
| Rate for Payer: Cofinity Commercial |
$1,320.28
|
| Rate for Payer: Cofinity Commercial |
$1,418.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$985.28
|
| Rate for Payer: Healthscope Commercial |
$1,182.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,182.34
|
| Rate for Payer: Meridian Medicaid |
$672.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,034.54
|
| Rate for Payer: PACE SWMI |
$985.28
|
| Rate for Payer: PHP Medicare Advantage |
$985.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,606.49
|
| Rate for Payer: Priority Health Medicare |
$985.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,606.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.84
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$598.53 |
| Max. Negotiated Rate |
$2,714.41 |
| Rate for Payer: Aetna Commercial |
$1,232.28
|
| Rate for Payer: Aetna Medicare |
$919.61
|
| Rate for Payer: BCBS Complete |
$628.46
|
| Rate for Payer: BCBS MAPPO |
$919.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,714.41
|
| Rate for Payer: BCN Commercial |
$1,356.57
|
| Rate for Payer: BCN Medicare Advantage |
$919.61
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cofinity Commercial |
$1,324.24
|
| Rate for Payer: Cofinity Commercial |
$1,232.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$919.61
|
| Rate for Payer: Healthscope Commercial |
$1,103.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,103.53
|
| Rate for Payer: Meridian Medicaid |
$628.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$965.59
|
| Rate for Payer: PACE SWMI |
$919.61
|
| Rate for Payer: PHP Medicare Advantage |
$919.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,217.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,500.04
|
| Rate for Payer: Priority Health Medicare |
$919.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,500.04
|
| Rate for Payer: UHC Medicare Advantage |
$947.20
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$4,902.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$3,431.40 |
| Rate for Payer: Aetna Commercial |
$1,022.53
|
| Rate for Payer: Aetna Medicare |
$763.08
|
| Rate for Payer: BCBS Complete |
$521.56
|
| Rate for Payer: BCBS MAPPO |
$763.08
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$1,126.40
|
| Rate for Payer: BCN Medicare Advantage |
$763.08
|
| Rate for Payer: Cash Price |
$3,921.60
|
| Rate for Payer: Cash Price |
$3,921.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.84
|
| Rate for Payer: Cofinity Commercial |
$1,022.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.08
|
| Rate for Payer: Healthscope Commercial |
$915.70
|
| Rate for Payer: Healthscope Whirlpool |
$915.70
|
| Rate for Payer: Meridian Medicaid |
$521.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$801.23
|
| Rate for Payer: PACE SWMI |
$763.08
|
| Rate for Payer: PHP Medicare Advantage |
$763.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,431.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,245.52
|
| Rate for Payer: Priority Health Medicare |
$763.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,245.52
|
| Rate for Payer: UHC Medicare Advantage |
$785.97
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$1,972.94
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$517.21 |
| Max. Negotiated Rate |
$1,540.55 |
| Rate for Payer: Aetna Commercial |
$1,265.90
|
| Rate for Payer: Aetna Medicare |
$944.70
|
| Rate for Payer: BCBS Complete |
$645.46
|
| Rate for Payer: BCBS MAPPO |
$944.70
|
| Rate for Payer: BCBS Trust/PPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$944.70
|
| Rate for Payer: Cash Price |
$1,578.35
|
| Rate for Payer: Cash Price |
$1,578.35
|
| Rate for Payer: Cofinity Commercial |
$1,360.37
|
| Rate for Payer: Cofinity Commercial |
$1,265.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.70
|
| Rate for Payer: Healthscope Commercial |
$1,133.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,133.64
|
| Rate for Payer: Meridian Medicaid |
$645.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$991.94
|
| Rate for Payer: PACE SWMI |
$944.70
|
| Rate for Payer: PHP Medicare Advantage |
$944.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,381.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,540.55
|
| Rate for Payer: Priority Health Medicare |
$944.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,540.55
|
| Rate for Payer: UHC Medicare Advantage |
$973.04
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$190.72 |
| Rate for Payer: Aetna Commercial |
$122.01
|
| Rate for Payer: Aetna Medicare |
$91.05
|
| Rate for Payer: BCBS Complete |
$61.51
|
| Rate for Payer: BCBS MAPPO |
$91.05
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$133.89
|
| Rate for Payer: BCN Medicare Advantage |
$91.05
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$131.11
|
| Rate for Payer: Cofinity Commercial |
$122.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.05
|
| Rate for Payer: Healthscope Commercial |
$100.16
|
| Rate for Payer: Healthscope Whirlpool |
$100.16
|
| Rate for Payer: Meridian Medicaid |
$61.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.60
|
| Rate for Payer: PACE SWMI |
$91.05
|
| Rate for Payer: PHP Medicare Advantage |
$91.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.36
|
| Rate for Payer: Priority Health Medicare |
$91.05
|
| Rate for Payer: Priority Health Narrow Network |
$117.36
|
| Rate for Payer: UHC Medicare Advantage |
$93.78
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$1,537.35 |
| Rate for Payer: Aetna Commercial |
$143.09
|
| Rate for Payer: Aetna Medicare |
$106.78
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$106.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.35
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$106.78
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$153.76
|
| Rate for Payer: Cofinity Commercial |
$143.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.78
|
| Rate for Payer: Healthscope Commercial |
$117.46
|
| Rate for Payer: Healthscope Whirlpool |
$117.46
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.12
|
| Rate for Payer: PACE SWMI |
$106.78
|
| Rate for Payer: PHP Medicare Advantage |
$106.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.92
|
| Rate for Payer: Priority Health Medicare |
$106.78
|
| Rate for Payer: Priority Health Narrow Network |
$137.92
|
| Rate for Payer: UHC Medicare Advantage |
$109.98
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,363.01 |
| Rate for Payer: Aetna Commercial |
$228.31
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.01
|
| Rate for Payer: BCN Commercial |
$183.78
|
| Rate for Payer: BCN Medicare Advantage |
$170.38
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$228.31
|
| Rate for Payer: Cofinity Commercial |
$245.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.38
|
| Rate for Payer: Healthscope Commercial |
$187.42
|
| Rate for Payer: Healthscope Whirlpool |
$187.42
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.90
|
| Rate for Payer: PACE SWMI |
$170.38
|
| Rate for Payer: PHP Medicare Advantage |
$170.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.73
|
| Rate for Payer: Priority Health Medicare |
$170.38
|
| Rate for Payer: Priority Health Narrow Network |
$219.73
|
| Rate for Payer: UHC Medicare Advantage |
$175.49
|
|
