|
POTASSIUM CHLORIDE 20 MEQ/L IN D5W-0.9% NACL 1.5X MAINTENANCE
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338080304
|
| Hospital Charge Code |
300207
|
|
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 DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
9801
|
|
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 DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338067104
|
| Hospital Charge Code |
9801
|
|
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 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$18.56 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Commercial |
$18.82
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: ASR ASR |
$18.00
|
| Rate for Payer: ASR ASR |
$20.28
|
| Rate for Payer: ASR Commercial |
$20.28
|
| Rate for Payer: ASR Commercial |
$18.00
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.12
|
| Rate for Payer: BCN Commercial |
$16.21
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$17.45
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.73
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$20.91
|
| Rate for Payer: Healthscope Whirlpool |
$18.00
|
| Rate for Payer: Healthscope Whirlpool |
$20.28
|
| Rate for Payer: Mclaren Commercial |
$16.70
|
| Rate for Payer: Mclaren Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.32
|
| Rate for Payer: Priority Health Narrow Network |
$14.66
|
| Rate for Payer: Priority Health Narrow Network |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.33
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.91
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
6429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$20.91 |
| Rate for Payer: Aetna Commercial |
$18.82
|
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: ASR ASR |
$18.00
|
| Rate for Payer: ASR ASR |
$20.28
|
| Rate for Payer: ASR Commercial |
$18.00
|
| Rate for Payer: ASR Commercial |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.21
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$17.45
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.73
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$20.91
|
| Rate for Payer: Healthscope Whirlpool |
$20.28
|
| Rate for Payer: Healthscope Whirlpool |
$18.00
|
| Rate for Payer: Mclaren Commercial |
$16.70
|
| Rate for Payer: Mclaren Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: Nomi Health Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.33
|
| 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 00338069504
|
| Hospital Charge Code |
11082
|
|
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 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338069504
|
| Hospital Charge Code |
11082
|
|
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 ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.97
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Trust/PPO |
$219.09
|
| 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 |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$241.97
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| Rate for Payer: ASR ASR |
$260.78
|
| Rate for Payer: ASR Commercial |
$260.78
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: BCBS Trust/PPO |
$220.16
|
| 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 |
$241.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Nomi Health Commercial |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.57
|
| Rate for Payer: Priority Health Narrow Network |
$188.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.59
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$199.22
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: ASR ASR |
$214.71
|
| Rate for Payer: ASR Commercial |
$214.71
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Trust/PPO |
$181.26
|
| Rate for Payer: BCN Commercial |
$171.61
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$208.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$221.35
|
| Rate for Payer: Healthscope Whirlpool |
$214.71
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Narrow Network |
$155.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
NDC 60687046611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| 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 Commercial |
$2.06
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
NDC 60687046611
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: ASR ASR |
$2.35
|
| Rate for Payer: ASR Commercial |
$2.35
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| 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 Commercial |
$2.06
|
| Rate for Payer: Nomi Health Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.12
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.13
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.46 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: ASR ASR |
$234.98
|
| Rate for Payer: ASR Commercial |
$234.98
|
| Rate for Payer: BCBS Trust/PPO |
$197.41
|
| 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 |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: Nomi Health Commercial |
$198.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.18
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$242.25
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$121.12
|
| Rate for Payer: ASR ASR |
$234.98
|
| Rate for Payer: ASR Commercial |
$234.98
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS Trust/PPO |
$198.38
|
| 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 |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.91
|
| Rate for Payer: Nomi Health Commercial |
$198.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.26
|
| Rate for Payer: Priority Health Narrow Network |
$169.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.18
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687069711
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: ASR ASR |
$2.36
|
| Rate for Payer: ASR Commercial |
$2.36
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Healthscope Whirlpool |
$2.36
|
| 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: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.14
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: ASR ASR |
$2.61
|
| Rate for Payer: ASR Commercial |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| 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 Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.37
|
|
|
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 |
$1.58 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: ASR ASR |
$2.36
|
| Rate for Payer: ASR Commercial |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Healthscope Whirlpool |
$2.36
|
| 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: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.14
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$199.22
|
| Rate for Payer: ASR ASR |
$214.71
|
| Rate for Payer: ASR Commercial |
$214.71
|
| Rate for Payer: BCBS Trust/PPO |
$180.38
|
| Rate for Payer: BCN Commercial |
$171.61
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$208.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$221.35
|
| Rate for Payer: Healthscope Whirlpool |
$214.71
|
| Rate for Payer: Mclaren Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.79
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: ASR Commercial |
$253.02
|
| Rate for Payer: BCBS Trust/PPO |
$212.57
|
| 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 Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 00832532311
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: ASR Commercial |
$253.02
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: BCBS Trust/PPO |
$213.61
|
| 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 Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: 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
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 60687081011
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: ASR Commercial |
$4.54
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Healthscope Whirlpool |
$4.54
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.10
|
| Rate for Payer: Priority Health Narrow Network |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
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 |
$158.08 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: ASR ASR |
$235.90
|
| Rate for Payer: ASR Commercial |
$235.90
|
| Rate for Payer: BCBS Trust/PPO |
$198.18
|
| Rate for Payer: BCN Commercial |
$188.55
|
| 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 |
$243.20
|
| Rate for Payer: Healthscope Whirlpool |
$235.90
|
| 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: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$243.20
|
|
|
Service Code
|
NDC 60687069701
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna Medicare |
$121.60
|
| Rate for Payer: ASR ASR |
$235.90
|
| Rate for Payer: ASR Commercial |
$235.90
|
| Rate for Payer: BCBS Complete |
$97.28
|
| Rate for Payer: BCBS Trust/PPO |
$199.16
|
| Rate for Payer: BCN Commercial |
$188.55
|
| 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 |
$243.20
|
| Rate for Payer: Healthscope Whirlpool |
$235.90
|
| 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: Priority Health Cigna Priority Health |
$158.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.09
|
| Rate for Payer: Priority Health Narrow Network |
$170.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.02
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$374.12
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.18 |
| Max. Negotiated Rate |
$374.12 |
| Rate for Payer: Aetna Commercial |
$336.71
|
| Rate for Payer: ASR ASR |
$362.90
|
| Rate for Payer: ASR Commercial |
$362.90
|
| Rate for Payer: BCBS Trust/PPO |
$304.87
|
| Rate for Payer: BCN Commercial |
$290.06
|
| Rate for Payer: Cash Price |
$299.30
|
| Rate for Payer: Cofinity Commercial |
$351.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.30
|
| Rate for Payer: Healthscope Commercial |
$374.12
|
| Rate for Payer: Healthscope Whirlpool |
$362.90
|
| Rate for Payer: Mclaren Commercial |
$336.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.00
|
| Rate for Payer: Nomi Health Commercial |
$306.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.23
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$374.12
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.65 |
| Max. Negotiated Rate |
$374.12 |
| Rate for Payer: Aetna Commercial |
$336.71
|
| Rate for Payer: Aetna Medicare |
$187.06
|
| Rate for Payer: ASR ASR |
$362.90
|
| Rate for Payer: ASR Commercial |
$362.90
|
| Rate for Payer: BCBS Complete |
$149.65
|
| Rate for Payer: BCBS Trust/PPO |
$306.37
|
| Rate for Payer: BCN Commercial |
$290.06
|
| Rate for Payer: Cash Price |
$299.30
|
| Rate for Payer: Cofinity Commercial |
$351.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.30
|
| Rate for Payer: Healthscope Commercial |
$374.12
|
| Rate for Payer: Healthscope Whirlpool |
$362.90
|
| Rate for Payer: Mclaren Commercial |
$336.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.00
|
| Rate for Payer: Nomi Health Commercial |
$306.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.80
|
| Rate for Payer: Priority Health Narrow Network |
$262.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.23
|
|
