|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$286.90
|
|
|
Service Code
|
NDC 574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.18 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$258.21
|
| Rate for Payer: ASR ASR |
$278.29
|
| Rate for Payer: BCBS Trust/PPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$235.60
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$269.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$278.29
|
| Rate for Payer: Healthscope Whirlpool |
$286.90
|
| Rate for Payer: Mclaren Commercial |
$258.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Nomi Health Commercial |
$235.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.47
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$227.05
|
|
|
Service Code
|
NDC 904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna Commercial |
$204.34
|
| Rate for Payer: Aetna Medicare |
$84.01
|
| Rate for Payer: ASR ASR |
$220.24
|
| Rate for Payer: BCBS Complete |
$90.82
|
| Rate for Payer: BCBS Trust/PPO |
$187.20
|
| Rate for Payer: BCN Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Commercial |
$213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$220.24
|
| Rate for Payer: Healthscope Whirlpool |
$227.05
|
| Rate for Payer: Mclaren Commercial |
$204.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.94
|
| Rate for Payer: Priority Health Narrow Network |
$159.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.80
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687069711
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: ASR ASR |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Healthscope Whirlpool |
$2.43
|
| Rate for Payer: Mclaren Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.14
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 72888007501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$105.21
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$234.45
|
| Rate for Payer: BCN Commercial |
$234.45
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 60687069701
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: ASR ASR |
$235.90
|
| Rate for Payer: BCBS Trust/PPO |
$199.72
|
| Rate for Payer: BCN Commercial |
$199.72
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$228.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$235.90
|
| Rate for Payer: Healthscope Whirlpool |
$243.20
|
| Rate for Payer: Mclaren Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$199.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$227.05
|
|
|
Service Code
|
NDC 904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.29 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna Commercial |
$204.34
|
| Rate for Payer: ASR ASR |
$220.24
|
| Rate for Payer: BCBS Trust/PPO |
$186.45
|
| Rate for Payer: BCN Commercial |
$186.45
|
| Rate for Payer: Cash Price |
$181.64
|
| Rate for Payer: Cofinity Commercial |
$213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.64
|
| Rate for Payer: Healthscope Commercial |
$220.24
|
| Rate for Payer: Healthscope Whirlpool |
$227.05
|
| Rate for Payer: Mclaren Commercial |
$204.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.99
|
| Rate for Payer: Nomi Health Commercial |
$186.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.80
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 60687081011
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: ASR ASR |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Healthscope Whirlpool |
$2.27
|
| Rate for Payer: Mclaren Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.93
|
| Rate for Payer: Nomi Health Commercial |
$1.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.00
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: Aetna Medicare |
$96.51
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: BCBS Trust/PPO |
$215.07
|
| Rate for Payer: BCN Commercial |
$215.07
|
| 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 |
$253.02
|
| Rate for Payer: Healthscope Whirlpool |
$260.85
|
| Rate for Payer: Mclaren Commercial |
$234.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$228.56
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 72888007501
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$233.51
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
NDC 70121172201
|
| Hospital Charge Code |
151984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
NDC 70121172209
|
| Hospital Charge Code |
151984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
NDC 70121172209
|
| Hospital Charge Code |
151984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
NDC 70121172201
|
| Hospital Charge Code |
151984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
OP
|
$259.20
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$233.28
|
| Rate for Payer: Aetna Medicare |
$95.90
|
| Rate for Payer: ASR ASR |
$251.42
|
| Rate for Payer: BCBS Complete |
$103.68
|
| Rate for Payer: BCBS Trust/PPO |
$213.71
|
| Rate for Payer: BCN Commercial |
$213.71
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$243.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| Rate for Payer: Healthscope Whirlpool |
$259.20
|
| Rate for Payer: Mclaren Commercial |
$233.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.32
|
| Rate for Payer: Nomi Health Commercial |
$212.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.11
|
| Rate for Payer: Priority Health Narrow Network |
$181.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.10
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$259.20
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$233.28
|
| Rate for Payer: ASR ASR |
$251.42
|
| Rate for Payer: BCBS Trust/PPO |
$212.86
|
| Rate for Payer: BCN Commercial |
$212.86
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$243.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| Rate for Payer: Healthscope Whirlpool |
$259.20
|
| Rate for Payer: Mclaren Commercial |
$233.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.32
|
| Rate for Payer: Nomi Health Commercial |
$212.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.10
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$464.55
|
|
|
Service Code
|
NDC 39328000810
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.41 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: BCBS Trust/PPO |
$381.49
|
| Rate for Payer: BCN Commercial |
$381.49
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$450.61
|
| Rate for Payer: Healthscope Whirlpool |
$464.55
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
OP
|
$464.55
|
|
|
Service Code
|
NDC 39328000810
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.88 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: Aetna Medicare |
$171.88
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: BCBS Complete |
$185.82
|
| Rate for Payer: BCBS Trust/PPO |
$383.02
|
| Rate for Payer: BCN Commercial |
$383.02
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$450.61
|
| Rate for Payer: Healthscope Whirlpool |
$464.55
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.87
|
| Rate for Payer: Nomi Health Commercial |
$380.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$407.04
|
| Rate for Payer: Priority Health Narrow Network |
$325.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$156.38
|
|
|
Service Code
|
NDC 409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.29 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: BCBS Trust/PPO |
$128.42
|
| Rate for Payer: BCN Commercial |
$128.42
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Healthscope Whirlpool |
$156.38
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.62
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$307.98 |
| 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 |
$337.22
|
| Rate for Payer: BCN Commercial |
$337.22
|
| 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 |
$398.32
|
| Rate for Payer: Healthscope Whirlpool |
$410.64
|
| Rate for Payer: Mclaren Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$336.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.36
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$156.38
|
|
|
Service Code
|
NDC 409729511
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: Aetna Medicare |
$57.86
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: BCBS Trust/PPO |
$128.94
|
| Rate for Payer: BCN Commercial |
$128.94
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Healthscope Whirlpool |
$156.38
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow Network |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.62
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$250.13
|
|
|
Service Code
|
NDC 70069074701
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$250.12 |
| Rate for Payer: Aetna Commercial |
$225.11
|
| Rate for Payer: ASR ASR |
$242.62
|
| Rate for Payer: BCBS Trust/PPO |
$205.40
|
| Rate for Payer: BCN Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cofinity Commercial |
$235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.10
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.12
|
| Rate for Payer: Mclaren Commercial |
$225.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.61
|
| Rate for Payer: Nomi Health Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.11
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$156.38
|
|
|
Service Code
|
NDC 409729511
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.29 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: BCBS Trust/PPO |
$128.42
|
| Rate for Payer: BCN Commercial |
$128.42
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Healthscope Whirlpool |
$156.38
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.62
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$250.13
|
|
|
Service Code
|
NDC 70069074725
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$250.12 |
| Rate for Payer: Aetna Commercial |
$225.11
|
| Rate for Payer: ASR ASR |
$242.62
|
| Rate for Payer: BCBS Trust/PPO |
$205.40
|
| Rate for Payer: BCN Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cofinity Commercial |
$235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.10
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.12
|
| Rate for Payer: Mclaren Commercial |
$225.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.61
|
| Rate for Payer: Nomi Health Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.11
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$156.38
|
|
|
Service Code
|
NDC 409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: Aetna Medicare |
$57.86
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: BCBS Trust/PPO |
$128.94
|
| Rate for Payer: BCN Commercial |
$128.94
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Healthscope Whirlpool |
$156.38
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow Network |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.62
|
|
