|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
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 NON PVC BAG
|
Facility
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| 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: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
IP
|
$47.85
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| 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 Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
NDC 0223-1760-01
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: ASR ASR |
$227.95
|
| Rate for Payer: BCBS Trust/PPO |
$182.20
|
| Rate for Payer: BCN Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$220.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$235.00
|
| Rate for Payer: Healthscope Whirlpool |
$227.95
|
| Rate for Payer: Mclaren Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.80
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
IP
|
$3.97
|
|
|
Service Code
|
NDC 7733383525
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: ASR ASR |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Healthscope Whirlpool |
$3.85
|
| Rate for Payer: Mclaren Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.49
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
IP
|
$397.15
|
|
|
Service Code
|
NDC 7733383510
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$397.15 |
| Rate for Payer: Aetna Commercial |
$357.44
|
| Rate for Payer: ASR ASR |
$385.24
|
| Rate for Payer: BCBS Trust/PPO |
$307.91
|
| Rate for Payer: BCN Commercial |
$307.91
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$373.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$397.15
|
| Rate for Payer: Healthscope Whirlpool |
$385.24
|
| Rate for Payer: Mclaren Commercial |
$357.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.49
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0054-03
|
| Hospital Charge Code |
7321
|
|
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 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
IP
|
$87.40
|
|
|
Service Code
|
NDC 63323-530-75
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.76
|
| Rate for Payer: BCN Commercial |
$67.76
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$82.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
IP
|
$87.40
|
|
|
Service Code
|
NDC 63323-530-21
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.76
|
| Rate for Payer: BCN Commercial |
$67.76
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$82.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.92
|
| Rate for Payer: Healthscope Commercial |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$103.50
|
|
|
Service Code
|
NDC 63323-187-30
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$93.15
|
| Rate for Payer: ASR ASR |
$100.40
|
| Rate for Payer: BCBS Trust/PPO |
$80.24
|
| Rate for Payer: BCN Commercial |
$80.24
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cofinity Commercial |
$97.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.80
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Healthscope Whirlpool |
$100.40
|
| Rate for Payer: Mclaren Commercial |
$93.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.08
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
IP
|
$25.94
|
|
|
Service Code
|
NDC 225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$20.11
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$25.94
|
| Rate for Payer: Healthscope Whirlpool |
$25.16
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$46.35
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: ASR ASR |
$44.96
|
| Rate for Payer: BCBS Trust/PPO |
$35.94
|
| Rate for Payer: BCN Commercial |
$35.94
|
| Rate for Payer: Cash Price |
$37.08
|
| Rate for Payer: Cofinity Commercial |
$43.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.08
|
| Rate for Payer: Healthscope Commercial |
$46.35
|
| Rate for Payer: Healthscope Whirlpool |
$44.96
|
| Rate for Payer: Mclaren Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.79
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
IP
|
$17.82
|
|
|
Service Code
|
NDC 121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.29
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
IP
|
$232.75
|
|
|
Service Code
|
NDC 6498010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.92 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.48
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$180.45
|
| Rate for Payer: BCN Commercial |
$180.45
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$232.75
|
| Rate for Payer: Healthscope Whirlpool |
$225.77
|
| Rate for Payer: Mclaren Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
IP
|
$131.61
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Aetna Commercial |
$118.45
|
| Rate for Payer: ASR ASR |
$127.66
|
| Rate for Payer: BCBS Trust/PPO |
$102.04
|
| Rate for Payer: BCN Commercial |
$102.04
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$123.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$131.61
|
| Rate for Payer: Healthscope Whirlpool |
$127.66
|
| Rate for Payer: Mclaren Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.82
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
IP
|
$149.22
|
|
|
Service Code
|
NDC 8065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: ASR ASR |
$144.74
|
| Rate for Payer: BCBS Trust/PPO |
$115.69
|
| Rate for Payer: BCN Commercial |
$115.69
|
| Rate for Payer: Cash Price |
$119.38
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.38
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Healthscope Whirlpool |
$144.74
|
| Rate for Payer: Mclaren Commercial |
$134.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.31
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
IP
|
$1,406.15
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$984.30 |
| Max. Negotiated Rate |
$1,406.15 |
| Rate for Payer: Aetna Commercial |
$1,265.54
|
| Rate for Payer: ASR ASR |
$1,363.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.19
|
| Rate for Payer: BCN Commercial |
$1,090.19
|
| Rate for Payer: Cash Price |
$1,124.92
|
| Rate for Payer: Cofinity Commercial |
$1,321.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,124.92
|
| Rate for Payer: Healthscope Commercial |
$1,406.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,363.97
|
| Rate for Payer: Mclaren Commercial |
$1,265.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,195.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,237.41
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$264.12
|
|
|
Service Code
|
NDC 14789-012-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.88 |
| Max. Negotiated Rate |
$264.12 |
| Rate for Payer: Aetna Commercial |
$237.71
|
| Rate for Payer: ASR ASR |
$256.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.77
|
| Rate for Payer: BCN Commercial |
$204.77
|
| Rate for Payer: Cash Price |
$211.30
|
| Rate for Payer: Cofinity Commercial |
$248.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.30
|
| Rate for Payer: Healthscope Commercial |
$264.12
|
| Rate for Payer: Healthscope Whirlpool |
$256.20
|
| Rate for Payer: Mclaren Commercial |
$237.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.43
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$996.95
|
|
|
Service Code
|
NDC 0187-4302-02
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$697.86 |
| Max. Negotiated Rate |
$996.95 |
| Rate for Payer: Aetna Commercial |
$897.26
|
| Rate for Payer: ASR ASR |
$967.04
|
| Rate for Payer: BCBS Trust/PPO |
$772.94
|
| Rate for Payer: BCN Commercial |
$772.94
|
| Rate for Payer: Cash Price |
$797.56
|
| Rate for Payer: Cofinity Commercial |
$937.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.56
|
| Rate for Payer: Healthscope Commercial |
$996.95
|
| Rate for Payer: Healthscope Whirlpool |
$967.04
|
| Rate for Payer: Mclaren Commercial |
$897.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$847.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$877.32
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$77.07
|
|
|
Service Code
|
NDC 71839-120-01
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: ASR ASR |
$74.76
|
| Rate for Payer: BCBS Trust/PPO |
$59.75
|
| Rate for Payer: BCN Commercial |
$59.75
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cofinity Commercial |
$72.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.66
|
| Rate for Payer: Healthscope Commercial |
$77.07
|
| Rate for Payer: Healthscope Whirlpool |
$74.76
|
| Rate for Payer: Mclaren Commercial |
$69.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.82
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$62.43
|
|
|
Service Code
|
NDC 42571-265-75
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: ASR ASR |
$60.56
|
| Rate for Payer: BCBS Trust/PPO |
$48.40
|
| Rate for Payer: BCN Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cofinity Commercial |
$58.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.43
|
| Rate for Payer: Healthscope Whirlpool |
$60.56
|
| Rate for Payer: Mclaren Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.94
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$51.22
|
|
|
Service Code
|
NDC 70436-028-80
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-72
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: BCBS Trust/PPO |
$191.06
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323-881-16
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$220.61 |
| Max. Negotiated Rate |
$315.16 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: BCBS Trust/PPO |
$244.34
|
| Rate for Payer: BCN Commercial |
$244.34
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$296.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$315.16
|
| Rate for Payer: Healthscope Whirlpool |
$305.71
|
| Rate for Payer: Mclaren Commercial |
$283.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.34
|
|
