|
POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: ASR ASR |
$14.71
|
| Rate for Payer: ASR Commercial |
$14.71
|
| Rate for Payer: BCBS Complete |
$6.07
|
| Rate for Payer: BCBS Trust/PPO |
$12.42
|
| Rate for Payer: BCN Commercial |
$11.76
|
| Rate for Payer: Cash Price |
$12.14
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.14
|
| Rate for Payer: Healthscope Commercial |
$15.17
|
| Rate for Payer: Healthscope Whirlpool |
$14.71
|
| Rate for Payer: Mclaren Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.89
|
| Rate for Payer: Nomi Health Commercial |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.29
|
| Rate for Payer: Priority Health Narrow Network |
$10.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.35
|
|
|
POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$15.17
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: ASR ASR |
$14.71
|
| Rate for Payer: ASR Commercial |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$11.76
|
| Rate for Payer: Cash Price |
$12.14
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.14
|
| Rate for Payer: Healthscope Commercial |
$15.17
|
| Rate for Payer: Healthscope Whirlpool |
$14.71
|
| Rate for Payer: Mclaren Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.89
|
| Rate for Payer: Nomi Health Commercial |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.35
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$74.97 |
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Commercial |
$72.37
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: ASR ASR |
$78.00
|
| Rate for Payer: ASR Commercial |
$78.00
|
| Rate for Payer: ASR Commercial |
$72.72
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCBS Trust/PPO |
$65.85
|
| Rate for Payer: BCN Commercial |
$62.34
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$75.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Healthscope Whirlpool |
$72.72
|
| Rate for Payer: Healthscope Whirlpool |
$78.00
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Mclaren Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$65.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.46
|
| Rate for Payer: Priority Health Narrow Network |
$56.37
|
| Rate for Payer: Priority Health Narrow Network |
$52.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
|
|
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 |
$52.27 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial |
$72.37
|
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: ASR ASR |
$78.00
|
| Rate for Payer: ASR Commercial |
$72.72
|
| Rate for Payer: ASR Commercial |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.53
|
| Rate for Payer: BCN Commercial |
$62.34
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$75.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Healthscope Whirlpool |
$78.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.72
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Mclaren Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Nomi Health Commercial |
$65.94
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.76
|
|
|
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 |
$8.22 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: ASR Commercial |
$19.92
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS Trust/PPO |
$16.82
|
| 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 Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.00
|
| Rate for Payer: Priority Health Narrow Network |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
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 |
$13.35 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: ASR Commercial |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.74
|
| 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 Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 00121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: ASR Commercial |
$15.56
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$12.44
|
| 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 |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$15.56
|
| 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: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: 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
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCN Commercial |
$9.38
|
| 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 |
$12.10
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.14
|
|
|
Service Code
|
NDC 00904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: ASR ASR |
$23.42
|
| Rate for Payer: ASR Commercial |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.67
|
| Rate for Payer: BCN Commercial |
$18.72
|
| 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 |
$24.14
|
| Rate for Payer: Healthscope Whirlpool |
$23.42
|
| Rate for Payer: Mclaren Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.52
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.24
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 00121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: ASR Commercial |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$12.44
|
| 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 |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$15.56
|
| 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: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 00121494800
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: ASR Commercial |
$15.56
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$12.44
|
| 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 |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$15.56
|
| 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: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: 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
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00904706188
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.38
|
| 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 |
$12.10
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: 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
|
$24.14
|
|
|
Service Code
|
NDC 00904706187
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: Aetna Medicare |
$12.07
|
| Rate for Payer: ASR ASR |
$23.42
|
| Rate for Payer: ASR Commercial |
$23.42
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$18.72
|
| 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 |
$24.14
|
| Rate for Payer: Healthscope Whirlpool |
$23.42
|
| Rate for Payer: Mclaren Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.52
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.69
|
| Rate for Payer: 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 |
$21.24
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 00121494815
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.56
|
| Rate for Payer: ASR Commercial |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$12.44
|
| 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 |
$16.04
|
| Rate for Payer: Healthscope Whirlpool |
$15.56
|
| 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: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
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 |
$13.35 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: ASR Commercial |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.74
|
| 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 Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID
|
Facility
|
OP
|
$20.54
|
|
|
Service Code
|
NDC 66689004701
|
| Hospital Charge Code |
6432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: ASR ASR |
$19.92
|
| Rate for Payer: ASR Commercial |
$19.92
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS Trust/PPO |
$16.82
|
| 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 Commercial |
$17.46
|
| Rate for Payer: Nomi Health Commercial |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.00
|
| Rate for Payer: Priority Health Narrow Network |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.08
|
|
|
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 |
$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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$95.70
|
|
|
Service Code
|
NDC 00264765200
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.28 |
| Max. Negotiated Rate |
$95.70 |
| Rate for Payer: Aetna Commercial |
$86.13
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: ASR ASR |
$92.83
|
| Rate for Payer: ASR Commercial |
$92.83
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$78.37
|
| 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 Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.22
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338080304
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.18
|
| 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 Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.93
|
| Rate for Payer: Priority Health Narrow Network |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 00264765200
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$95.70 |
| Rate for Payer: Aetna Commercial |
$86.13
|
| Rate for Payer: ASR ASR |
$92.83
|
| Rate for Payer: ASR Commercial |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$77.99
|
| 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 Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| 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 00338080304
|
| Hospital Charge Code |
9795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| 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 Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| 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
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
300206
|
|
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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.45% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
300206
|
|
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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.9% NACL 1.5X MAINTENANCE
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338080304
|
| Hospital Charge Code |
300207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| 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 Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
