|
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 |
$52.44 |
| 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 |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| 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 |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS (CODE)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.44 |
| 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 |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| 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 |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.37
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$44.32
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: Cash Price |
$43.00
|
| 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 |
$52.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.75
|
| Rate for Payer: Mclaren Commercial |
$48.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.17
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: BCN Commercial |
$55.17
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| 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 |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| 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 |
$40.31 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.37
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$44.14
|
| Rate for Payer: BCN Commercial |
$44.14
|
| 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 |
$52.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.75
|
| Rate for Payer: Mclaren Commercial |
$48.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.69
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
OP
|
$55.99
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$55.99 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Medicare |
$20.72
|
| Rate for Payer: ASR ASR |
$54.31
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$46.16
|
| Rate for Payer: BCN Commercial |
$46.16
|
| Rate for Payer: Cash Price |
$44.79
|
| 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 |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$55.99
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.69
|
| Rate for Payer: Priority Health Narrow Network |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
SODIUM CHLORIDE 0.9 % IV - DKA
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
161519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| 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 |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| 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 |
$41.99 |
| 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 |
$45.98
|
| Rate for Payer: BCN Commercial |
$45.98
|
| 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 |
$54.31
|
| Rate for Payer: Healthscope Whirlpool |
$55.99
|
| Rate for Payer: Mclaren Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Nomi Health Commercial |
$45.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.27
|
|
|
SODIUM CHLORIDE 0.9 % IV INFUSION (CODE)
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
163715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| 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 |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
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 |
$52.44 |
| 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 |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| 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 |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| 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: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$24.86
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.06
|
| 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 |
$35.89 |
| 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 |
$39.29
|
| Rate for Payer: BCN Commercial |
$39.29
|
| 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 |
$46.41
|
| Rate for Payer: Healthscope Whirlpool |
$47.85
|
| 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: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$55.17
|
| Rate for Payer: BCN Commercial |
$55.17
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Healthscope Whirlpool |
$67.19
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
SODIUM CHLORIDE 0.9 % IV NON PVC BAG
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
150715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.45
|
| Rate for Payer: BCN Commercial |
$39.45
|
| Rate for Payer: Cash Price |
$38.28
|
| 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 |
$46.41
|
| Rate for Payer: Healthscope Whirlpool |
$47.85
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.90
|
| Rate for Payer: BCN Commercial |
$191.90
|
| 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 |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.94
|
| Rate for Payer: Priority Health Narrow Network |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 77333083510
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| 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 |
$326.14
|
| Rate for Payer: BCN Commercial |
$326.14
|
| 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 |
$385.24
|
| Rate for Payer: Healthscope Whirlpool |
$397.15
|
| Rate for Payer: Mclaren Commercial |
$357.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.49
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 77333084410
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.13
|
| Rate for Payer: BCN Commercial |
$191.13
|
| 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 |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.26
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.26
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 77333083525
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| 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 |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| 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 |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.97
|
| Rate for Payer: Mclaren Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.50
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 77333083510
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.95 |
| Max. Negotiated Rate |
$397.15 |
| Rate for Payer: Aetna Commercial |
$357.44
|
| Rate for Payer: Aetna Medicare |
$146.95
|
| Rate for Payer: ASR ASR |
$385.24
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: BCBS Trust/PPO |
$327.45
|
| Rate for Payer: BCN Commercial |
$327.45
|
| 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 |
$385.24
|
| Rate for Payer: Healthscope Whirlpool |
$397.15
|
| Rate for Payer: Mclaren Commercial |
$357.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: Nomi Health Commercial |
$325.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.98
|
| Rate for Payer: Priority Health Narrow Network |
$278.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.49
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 77333083525
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: ASR ASR |
$3.85
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| 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 |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.97
|
| Rate for Payer: Mclaren Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.48
|
| Rate for Payer: Priority Health Narrow Network |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.50
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
NDC 223176001
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: ASR ASR |
$227.95
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$193.76
|
| Rate for Payer: BCN Commercial |
$193.76
|
| 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 |
$227.95
|
| Rate for Payer: Healthscope Whirlpool |
$235.00
|
| Rate for Payer: Mclaren Commercial |
$211.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: Nomi Health Commercial |
$192.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.91
|
| Rate for Payer: Priority Health Narrow Network |
$164.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.80
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 223176001
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.25 |
| 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 |
$192.98
|
| Rate for Payer: BCN Commercial |
$192.98
|
| 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 |
$227.95
|
| Rate for Payer: Healthscope Whirlpool |
$235.00
|
| Rate for Payer: Mclaren Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: Nomi Health Commercial |
$192.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.80
|
|
