|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Aetna Medicare |
$13.17
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$33.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$34.53
|
| Rate for Payer: Healthscope Whirlpool |
$35.60
|
| Rate for Payer: Mclaren Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.19
|
| Rate for Payer: Priority Health Narrow Network |
$24.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.33
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
NDC 409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Aetna Medicare |
$13.17
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$33.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$34.53
|
| Rate for Payer: Healthscope Whirlpool |
$35.60
|
| Rate for Payer: Mclaren Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.19
|
| Rate for Payer: Priority Health Narrow Network |
$24.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.33
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$29.23
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$33.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$34.53
|
| Rate for Payer: Healthscope Whirlpool |
$35.60
|
| Rate for Payer: Mclaren Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.33
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.16
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.37 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: ASR ASR |
$37.99
|
| Rate for Payer: BCBS Trust/PPO |
$32.16
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cofinity Commercial |
$36.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$37.99
|
| Rate for Payer: Healthscope Whirlpool |
$39.16
|
| Rate for Payer: Mclaren Commercial |
$35.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.46
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: ASR ASR |
$32.81
|
| Rate for Payer: BCBS Trust/PPO |
$27.77
|
| Rate for Payer: BCN Commercial |
$27.77
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$33.82
|
| Rate for Payer: Mclaren Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Nomi Health Commercial |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.76
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.16
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna Medicare |
$14.49
|
| Rate for Payer: ASR ASR |
$37.99
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$32.29
|
| Rate for Payer: BCN Commercial |
$32.29
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cofinity Commercial |
$36.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$37.99
|
| Rate for Payer: Healthscope Whirlpool |
$39.16
|
| Rate for Payer: Mclaren Commercial |
$35.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.31
|
| Rate for Payer: Priority Health Narrow Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.46
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.86
|
|
|
Service Code
|
NDC 81665020001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: Aetna Commercial |
$59.27
|
| Rate for Payer: ASR ASR |
$63.88
|
| Rate for Payer: BCBS Trust/PPO |
$54.08
|
| Rate for Payer: BCN Commercial |
$54.08
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$63.88
|
| Rate for Payer: Healthscope Whirlpool |
$65.86
|
| Rate for Payer: Mclaren Commercial |
$59.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Nomi Health Commercial |
$54.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.96
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.05
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$36.05 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: ASR ASR |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$29.60
|
| Rate for Payer: BCN Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cofinity Commercial |
$33.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.84
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Whirlpool |
$36.05
|
| Rate for Payer: Mclaren Commercial |
$32.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.64
|
| Rate for Payer: Nomi Health Commercial |
$29.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.72
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: Aetna Medicare |
$12.51
|
| Rate for Payer: ASR ASR |
$32.81
|
| Rate for Payer: BCBS Complete |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.88
|
| Rate for Payer: BCN Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$33.82
|
| Rate for Payer: Mclaren Commercial |
$30.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Nomi Health Commercial |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.63
|
| Rate for Payer: Priority Health Narrow Network |
$23.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.76
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
IP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: ASR ASR |
$32.81
|
| Rate for Payer: BCBS Trust/PPO |
$27.77
|
| Rate for Payer: BCN Commercial |
$27.77
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$33.82
|
| Rate for Payer: Mclaren Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Nomi Health Commercial |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.76
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION WRAPPER
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
302029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: Aetna Medicare |
$27.33
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Complete |
$29.55
|
| Rate for Payer: BCBS Trust/PPO |
$60.91
|
| Rate for Payer: BCN Commercial |
$60.91
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$64.72
|
| Rate for Payer: Priority Health Narrow Network |
$51.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
SODIUM BICARBONATE 50 MEQ/50 ML (8.4 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.66
|
| Rate for Payer: BCN Commercial |
$60.66
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 77333083110
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.72
|
| Rate for Payer: BCN Commercial |
$227.72
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: ASR ASR |
$155.01
|
| Rate for Payer: BCBS Trust/PPO |
$131.23
|
| Rate for Payer: BCN Commercial |
$131.23
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$150.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$155.01
|
| Rate for Payer: Healthscope Whirlpool |
$159.80
|
| Rate for Payer: Mclaren Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.62
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 77333083125
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 77333083110
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: BCBS Trust/PPO |
$228.63
|
| Rate for Payer: BCN Commercial |
$228.63
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.97
|
| Rate for Payer: Priority Health Narrow Network |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 77333083125
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.43
|
| Rate for Payer: Priority Health Narrow Network |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna Medicare |
$59.13
|
| Rate for Payer: ASR ASR |
$155.01
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$131.76
|
| Rate for Payer: BCN Commercial |
$131.76
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$150.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$155.01
|
| Rate for Payer: Healthscope Whirlpool |
$159.80
|
| Rate for Payer: Mclaren Commercial |
$143.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.02
|
| Rate for Payer: Priority Health Narrow Network |
$112.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.62
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.66
|
| Rate for Payer: BCN Commercial |
$60.66
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRINGE (CODE)
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
163719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: Aetna Medicare |
$27.33
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Complete |
$29.55
|
| Rate for Payer: BCBS Trust/PPO |
$60.91
|
| Rate for Payer: BCN Commercial |
$60.91
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$64.72
|
| Rate for Payer: Priority Health Narrow Network |
$51.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$48.14
|
|
|
Service Code
|
NDC 536122497
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$17.81
|
| Rate for Payer: ASR ASR |
$46.70
|
| Rate for Payer: BCBS Complete |
$19.26
|
| Rate for Payer: BCBS Trust/PPO |
$39.69
|
| Rate for Payer: BCN Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.52
|
| Rate for Payer: Healthscope Commercial |
$46.70
|
| Rate for Payer: Healthscope Whirlpool |
$48.14
|
| Rate for Payer: Mclaren Commercial |
$43.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.92
|
| Rate for Payer: Nomi Health Commercial |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.18
|
| Rate for Payer: Priority Health Narrow Network |
$33.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.37
|
|
