|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$2,605.95
|
|
|
Service Code
|
APR-DRG 5612
|
| Min. Negotiated Rate |
$2,356.09 |
| Max. Negotiated Rate |
$2,605.95 |
| Rate for Payer: BCBS Complete |
$2,605.95
|
| Rate for Payer: Mclaren Medicaid |
$2,481.86
|
| Rate for Payer: Meridian Medicaid |
$2,605.95
|
| Rate for Payer: PHP Medicaid |
$2,356.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,481.86
|
| Rate for Payer: UHC Medicaid |
$2,481.86
|
| Rate for Payer: UHCCP Medicaid |
$2,481.86
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$1,637.57
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$1,480.56 |
| Max. Negotiated Rate |
$1,637.57 |
| Rate for Payer: BCBS Complete |
$1,637.57
|
| Rate for Payer: Mclaren Medicaid |
$1,559.60
|
| Rate for Payer: Meridian Medicaid |
$1,637.57
|
| Rate for Payer: PHP Medicaid |
$1,480.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,559.60
|
| Rate for Payer: UHC Medicaid |
$1,559.60
|
| Rate for Payer: UHCCP Medicaid |
$1,559.60
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$9,431.45
|
|
|
Service Code
|
APR-DRG 5614
|
| Min. Negotiated Rate |
$8,527.16 |
| Max. Negotiated Rate |
$9,431.45 |
| Rate for Payer: BCBS Complete |
$9,431.45
|
| Rate for Payer: Mclaren Medicaid |
$8,982.33
|
| Rate for Payer: Meridian Medicaid |
$9,431.45
|
| Rate for Payer: PHP Medicaid |
$8,527.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,982.33
|
| Rate for Payer: UHC Medicaid |
$8,982.33
|
| Rate for Payer: UHCCP Medicaid |
$8,982.33
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$4,678.94
|
|
|
Service Code
|
APR-DRG 5613
|
| Min. Negotiated Rate |
$4,230.32 |
| Max. Negotiated Rate |
$4,678.94 |
| Rate for Payer: BCBS Complete |
$4,678.94
|
| Rate for Payer: Mclaren Medicaid |
$4,456.13
|
| Rate for Payer: Meridian Medicaid |
$4,678.94
|
| Rate for Payer: PHP Medicaid |
$4,230.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,456.13
|
| Rate for Payer: UHC Medicaid |
$4,456.13
|
| Rate for Payer: UHCCP Medicaid |
$4,456.13
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$16,147.96
|
|
|
Service Code
|
APR-DRG 5484
|
| Min. Negotiated Rate |
$14,599.69 |
| Max. Negotiated Rate |
$16,147.96 |
| Rate for Payer: BCBS Complete |
$16,147.96
|
| Rate for Payer: Mclaren Medicaid |
$15,379.01
|
| Rate for Payer: Meridian Medicaid |
$16,147.96
|
| Rate for Payer: PHP Medicaid |
$14,599.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,379.01
|
| Rate for Payer: UHC Medicaid |
$15,379.01
|
| Rate for Payer: UHCCP Medicaid |
$15,379.01
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$2,178.71
|
|
|
Service Code
|
APR-DRG 5481
|
| Min. Negotiated Rate |
$1,969.81 |
| Max. Negotiated Rate |
$2,178.71 |
| Rate for Payer: BCBS Complete |
$2,178.71
|
| Rate for Payer: Mclaren Medicaid |
$2,074.96
|
| Rate for Payer: Meridian Medicaid |
$2,178.71
|
| Rate for Payer: PHP Medicaid |
$1,969.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,074.96
|
| Rate for Payer: UHC Medicaid |
$2,074.96
|
| Rate for Payer: UHCCP Medicaid |
$2,074.96
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$8,684.87
|
|
|
Service Code
|
APR-DRG 5483
|
| Min. Negotiated Rate |
$7,852.16 |
| Max. Negotiated Rate |
$8,684.87 |
| Rate for Payer: BCBS Complete |
$8,684.87
|
| Rate for Payer: Mclaren Medicaid |
$8,271.30
|
| Rate for Payer: Meridian Medicaid |
$8,684.87
|
| Rate for Payer: PHP Medicaid |
$7,852.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,271.30
|
| Rate for Payer: UHC Medicaid |
$8,271.30
|
| Rate for Payer: UHCCP Medicaid |
$8,271.30
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$5,401.54
|
|
|
Service Code
|
APR-DRG 5482
|
| Min. Negotiated Rate |
$4,883.64 |
| Max. Negotiated Rate |
$5,401.54 |
| Rate for Payer: BCBS Complete |
$5,401.54
|
| Rate for Payer: Mclaren Medicaid |
$5,144.33
|
| Rate for Payer: Meridian Medicaid |
$5,401.54
|
| Rate for Payer: PHP Medicaid |
$4,883.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,144.33
|
| Rate for Payer: UHC Medicaid |
$5,144.33
|
| Rate for Payer: UHCCP Medicaid |
$5,144.33
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$74.97
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$74.97 |
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: ASR ASR |
$81.39
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: BCBS Trust/PPO |
$68.90
|
| Rate for Payer: BCBS Trust/PPO |
$61.56
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: BCN Commercial |
$61.56
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.97
|
| Rate for Payer: Healthscope Commercial |
$72.72
|
| Rate for Payer: Healthscope Commercial |
$81.39
|
| Rate for Payer: Healthscope Whirlpool |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$74.97
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Nomi Health Commercial |
$61.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.84
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$83.90
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.90 |
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Medicare |
$27.74
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: ASR ASR |
$81.39
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Complete |
$33.56
|
| Rate for Payer: BCBS Trust/PPO |
$69.18
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$61.81
|
| Rate for Payer: BCN Commercial |
$69.18
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.97
|
| Rate for Payer: Healthscope Commercial |
$81.39
|
| Rate for Payer: Healthscope Commercial |
$72.72
|
| Rate for Payer: Healthscope Whirlpool |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$74.97
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Nomi Health Commercial |
$61.47
|
| Rate for Payer: Nomi Health Commercial |
$68.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.84
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.14
|
|
|
Service Code
|
NDC 904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: ASR ASR |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$23.42
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.52
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.25
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$16.86
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$19.92
|
| Rate for Payer: Healthscope Whirlpool |
$20.54
|
| Rate for Payer: Mclaren Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.45
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: Aetna Medicare |
$5.93
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCN Commercial |
$13.22
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Whirlpool |
$16.04
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: Nomi Health Commercial |
$13.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.05
|
| Rate for Payer: Priority Health Narrow Network |
$11.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$10.71
|
|
|
Service Code
|
NDC 60687088416
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: ASR ASR |
$10.39
|
| Rate for Payer: BCBS Trust/PPO |
$8.80
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$10.39
|
| Rate for Payer: Healthscope Whirlpool |
$10.71
|
| Rate for Payer: Mclaren Commercial |
$9.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.43
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$17.93
|
|
|
Service Code
|
NDC 60687088444
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: ASR ASR |
$17.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.72
|
| Rate for Payer: BCN Commercial |
$14.72
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$16.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.34
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$16.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.24
|
| Rate for Payer: Nomi Health Commercial |
$14.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004730
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS Trust/PPO |
$16.93
|
| Rate for Payer: BCN Commercial |
$16.93
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$19.92
|
| Rate for Payer: Healthscope Whirlpool |
$20.54
|
| Rate for Payer: Mclaren Commercial |
$18.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.45
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.99
|
| Rate for Payer: Priority Health Narrow Network |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.98
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.60
|
| Rate for Payer: Priority Health Narrow Network |
$8.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$10.71
|
|
|
Service Code
|
NDC 60687088416
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: ASR ASR |
$10.39
|
| Rate for Payer: BCBS Complete |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$8.83
|
| Rate for Payer: BCN Commercial |
$8.83
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$10.39
|
| Rate for Payer: Healthscope Whirlpool |
$10.71
|
| Rate for Payer: Mclaren Commercial |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.39
|
| Rate for Payer: Priority Health Narrow Network |
$7.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.43
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$13.17
|
| Rate for Payer: BCN Commercial |
$13.17
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Whirlpool |
$16.04
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.63
|
| Rate for Payer: Nomi Health Commercial |
$13.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$28.19
|
|
|
Service Code
|
NDC 121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: ASR ASR |
$27.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$27.35
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCN Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.48
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$16.86
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.43
|
| Rate for Payer: Healthscope Commercial |
$19.92
|
| Rate for Payer: Healthscope Whirlpool |
$20.54
|
| Rate for Payer: Mclaren Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.45
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.07
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$17.93
|
|
|
Service Code
|
NDC 60687088444
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$17.93 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: ASR ASR |
$17.39
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$16.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.34
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$16.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.24
|
| Rate for Payer: Nomi Health Commercial |
$14.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.71
|
| Rate for Payer: Priority Health Narrow Network |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$28.19
|
|
|
Service Code
|
NDC 121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: ASR ASR |
$27.35
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$23.25
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.56
|
| Rate for Payer: Healthscope Commercial |
$27.35
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.70
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$24.14
|
|
|
Service Code
|
NDC 904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: ASR ASR |
$23.42
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$19.91
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$23.42
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$21.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.52
|
| Rate for Payer: Nomi Health Commercial |
$19.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.15
|
| Rate for Payer: Priority Health Narrow Network |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.25
|
|
