|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
IP
|
$7.13
|
|
|
Service Code
|
NDC 0536-2506-76
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: ASR ASR |
$6.92
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: Healthscope Whirlpool |
$6.92
|
| Rate for Payer: Mclaren Commercial |
$6.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.27
|
|
|
SODIUM CHLORIDE 0.9 % FLUSH SOLUTION 100 ML BAG
|
Facility
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
300165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
IP
|
$2.75
|
|
|
Service Code
|
NDC 0487-9301-33
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: ASR ASR |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.67
|
| Rate for Payer: Mclaren Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.42
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION
|
Facility
IP
|
$3.13
|
|
|
Service Code
|
NDC 0378-6985-01
|
| Hospital Charge Code |
7325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Healthscope Whirlpool |
$3.04
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 1.5 MAINTENANCE SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
180423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS 2X MAINTENANCE SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
300194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$41.47
|
|
|
Service Code
|
NDC 0338-0553-11
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: ASR ASR |
$40.23
|
| Rate for Payer: BCBS Trust/PPO |
$32.15
|
| Rate for Payer: BCN Commercial |
$32.15
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$38.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$41.47
|
| Rate for Payer: Healthscope Whirlpool |
$40.23
|
| Rate for Payer: Mclaren Commercial |
$37.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.49
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$41.47
|
|
|
Service Code
|
NDC 0338-0553-18
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: ASR ASR |
$40.23
|
| Rate for Payer: BCBS Trust/PPO |
$32.15
|
| Rate for Payer: BCN Commercial |
$32.15
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$38.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$41.47
|
| Rate for Payer: Healthscope Whirlpool |
$40.23
|
| Rate for Payer: Mclaren Commercial |
$37.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.49
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$44.66
|
|
|
Service Code
|
NDC 0338-9159-30
|
| Hospital Charge Code |
116170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$44.66 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: ASR ASR |
$43.32
|
| Rate for Payer: BCBS Trust/PPO |
$34.62
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.73
|
| Rate for Payer: Healthscope Commercial |
$44.66
|
| Rate for Payer: Healthscope Whirlpool |
$43.32
|
| Rate for Payer: Mclaren Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.30
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK HOSPIRA/PFIZER CUSTOM
|
Facility
IP
|
$66.42
|
|
|
Service Code
|
NDC 0409-7101-69
|
| Hospital Charge Code |
301508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$66.42 |
| Rate for Payer: Aetna Commercial |
$59.78
|
| Rate for Payer: ASR ASR |
$64.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.50
|
| Rate for Payer: BCN Commercial |
$51.50
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cofinity Commercial |
$62.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Healthscope Commercial |
$66.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.43
|
| Rate for Payer: Mclaren Commercial |
$59.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.45
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK HOSPIRA/PFIZER CUSTOM
|
Facility
IP
|
$66.42
|
|
|
Service Code
|
NDC 0409-7101-67
|
| Hospital Charge Code |
301508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$66.42 |
| Rate for Payer: Aetna Commercial |
$59.78
|
| Rate for Payer: ASR ASR |
$64.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.50
|
| Rate for Payer: BCN Commercial |
$51.50
|
| Rate for Payer: Cash Price |
$53.14
|
| Rate for Payer: Cofinity Commercial |
$62.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
| Rate for Payer: Healthscope Commercial |
$66.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.43
|
| Rate for Payer: Mclaren Commercial |
$59.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.45
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$62.71
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: ASR ASR |
$60.83
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCBS Trust/PPO |
$48.62
|
| Rate for Payer: BCBS Trust/PPO |
$43.41
|
| Rate for Payer: BCN Commercial |
$48.62
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Healthscope Whirlpool |
$60.83
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Mclaren Commercial |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$49.46
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.41
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (SD)
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
180607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (SD)
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
180607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: ASR ASR |
$60.83
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$48.62
|
| Rate for Payer: BCBS Trust/PPO |
$43.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$48.62
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Healthscope Whirlpool |
$60.83
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Mclaren Commercial |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.18
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (SD)
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
180607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.41
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
IP
|
$95.70
|
|
|
Service Code
|
NDC 0338-0047-27
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$95.70 |
| Rate for Payer: Aetna Commercial |
$86.13
|
| Rate for Payer: ASR ASR |
$92.83
|
| Rate for Payer: BCBS Trust/PPO |
$74.20
|
| 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 Multiplan/Beech St/PHCS |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.22
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0048-03
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV 1000 ML BAG (FOR BOLUS OR FLUSH)
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
301142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
400291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
IP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
IP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.41
|
| Rate for Payer: BCN Commercial |
$43.41
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Whirlpool |
$54.31
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
