|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 9900000929
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| 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 |
$2.62
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.36
|
| Rate for Payer: Priority Health Narrow Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.37
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 70756066360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 70756066360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.00
|
| Rate for Payer: Priority Health Narrow Network |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 9900000929
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| 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 |
$2.22
|
| Rate for Payer: BCN Commercial |
$2.22
|
| 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 |
$2.62
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.37
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$87.40
|
|
|
Service Code
|
NDC 63323053021
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.55 |
| 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 |
$71.77
|
| Rate for Payer: BCN Commercial |
$71.77
|
| 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 |
$84.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.40
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$87.40
|
|
|
Service Code
|
NDC 63323053075
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Aetna Medicare |
$32.34
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.06
|
| Rate for Payer: BCN Commercial |
$72.06
|
| 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 |
$84.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.40
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.58
|
| Rate for Payer: Priority Health Narrow Network |
$61.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 338005403
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| 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: 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 |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 338005403
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| 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 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$87.40
|
|
|
Service Code
|
NDC 63323053075
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.55 |
| 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 |
$71.77
|
| Rate for Payer: BCN Commercial |
$71.77
|
| 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 |
$84.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.40
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
OP
|
$87.40
|
|
|
Service Code
|
NDC 63323053021
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Aetna Medicare |
$32.34
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.06
|
| Rate for Payer: BCN Commercial |
$72.06
|
| 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 |
$84.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.40
|
| Rate for Payer: Mclaren Commercial |
$78.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.29
|
| Rate for Payer: Nomi Health Commercial |
$71.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.58
|
| Rate for Payer: Priority Health Narrow Network |
$61.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Aetna Commercial |
$132.97
|
| Rate for Payer: Aetna Medicare |
$54.67
|
| Rate for Payer: ASR ASR |
$143.32
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Trust/PPO |
$121.82
|
| Rate for Payer: BCN Commercial |
$121.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$138.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$143.32
|
| Rate for Payer: Healthscope Whirlpool |
$147.75
|
| Rate for Payer: Mclaren Commercial |
$132.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.46
|
| Rate for Payer: Priority Health Narrow Network |
$103.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.02
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.81 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Aetna Commercial |
$132.97
|
| Rate for Payer: ASR ASR |
$143.32
|
| Rate for Payer: BCBS Trust/PPO |
$121.33
|
| Rate for Payer: BCN Commercial |
$121.33
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$138.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$143.32
|
| Rate for Payer: Healthscope Whirlpool |
$147.75
|
| Rate for Payer: Mclaren Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.02
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Aetna Commercial |
$132.97
|
| Rate for Payer: Aetna Medicare |
$54.67
|
| Rate for Payer: ASR ASR |
$143.32
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Trust/PPO |
$121.82
|
| Rate for Payer: BCN Commercial |
$121.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$138.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$143.32
|
| Rate for Payer: Healthscope Whirlpool |
$147.75
|
| Rate for Payer: Mclaren Commercial |
$132.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.46
|
| Rate for Payer: Priority Health Narrow Network |
$103.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.02
|
|
|
SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.75
|
|
|
Service Code
|
NDC 63323009301
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.81 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Aetna Commercial |
$132.97
|
| Rate for Payer: ASR ASR |
$143.32
|
| Rate for Payer: BCBS Trust/PPO |
$121.33
|
| Rate for Payer: BCN Commercial |
$121.33
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$138.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.20
|
| Rate for Payer: Healthscope Commercial |
$143.32
|
| Rate for Payer: Healthscope Whirlpool |
$147.75
|
| Rate for Payer: Mclaren Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.59
|
| Rate for Payer: Nomi Health Commercial |
$121.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.02
|
|
|
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 |
$19.45 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: Aetna Commercial |
$23.34
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$21.30
|
| 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 |
$25.16
|
| Rate for Payer: Healthscope Whirlpool |
$25.94
|
| Rate for Payer: Mclaren Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: Aetna Commercial |
$23.34
|
| Rate for Payer: Aetna Medicare |
$9.60
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| 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 |
$25.16
|
| Rate for Payer: Healthscope Whirlpool |
$25.94
|
| Rate for Payer: Mclaren Commercial |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.73
|
| Rate for Payer: Priority Health Narrow Network |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$19.64
|
|
|
Service Code
|
NDC 121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$16.20
|
| Rate for Payer: BCN Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health Narrow Network |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.29
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
NDC 121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: ASR ASR |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.64
|
| Rate for Payer: Mclaren Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.70
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.29
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: Aetna Medicare |
$17.15
|
| Rate for Payer: ASR ASR |
$44.96
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$38.22
|
| 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 |
$44.96
|
| Rate for Payer: Healthscope Whirlpool |
$46.35
|
| Rate for Payer: Mclaren Commercial |
$41.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.40
|
| Rate for Payer: Nomi Health Commercial |
$38.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.62
|
| Rate for Payer: Priority Health Narrow Network |
$32.49
|
| 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
|
$46.35
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.77 |
| 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 |
$38.07
|
| Rate for Payer: BCN Commercial |
$38.07
|
| 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 |
$44.96
|
| Rate for Payer: Healthscope Whirlpool |
$46.35
|
| Rate for Payer: Mclaren Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.40
|
| Rate for Payer: Nomi Health Commercial |
$38.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.79
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.44 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$269.32
|
| Rate for Payer: ASR ASR |
$290.27
|
| Rate for Payer: BCBS Trust/PPO |
$245.74
|
| Rate for Payer: BCN Commercial |
$245.74
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Healthscope Whirlpool |
$299.25
|
| Rate for Payer: Mclaren Commercial |
$269.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.34
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$269.32
|
| Rate for Payer: Aetna Medicare |
$110.72
|
| Rate for Payer: ASR ASR |
$290.27
|
| Rate for Payer: BCBS Complete |
$119.70
|
| Rate for Payer: BCBS Trust/PPO |
$246.73
|
| Rate for Payer: BCN Commercial |
$246.73
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Healthscope Whirlpool |
$299.25
|
| Rate for Payer: Mclaren Commercial |
$269.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.20
|
| Rate for Payer: Priority Health Narrow Network |
$209.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.34
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
IP
|
$137.97
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.18
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: BCBS Trust/PPO |
$113.30
|
| Rate for Payer: BCN Commercial |
$113.30
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$129.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$133.83
|
| Rate for Payer: Healthscope Whirlpool |
$137.97
|
| Rate for Payer: Mclaren Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.42
|
|
|
SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS
|
Facility
|
OP
|
$137.97
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
24932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.18
|
| Rate for Payer: Aetna Medicare |
$51.05
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$113.76
|
| Rate for Payer: BCN Commercial |
$113.76
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$129.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$133.83
|
| Rate for Payer: Healthscope Whirlpool |
$137.97
|
| Rate for Payer: Mclaren Commercial |
$124.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.28
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.42
|
|
|
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 |
$111.92 |
| 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 |
$122.54
|
| Rate for Payer: BCN Commercial |
$122.54
|
| 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 |
$144.74
|
| Rate for Payer: Healthscope Whirlpool |
$149.22
|
| Rate for Payer: Mclaren Commercial |
$134.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.84
|
| Rate for Payer: Nomi Health Commercial |
$122.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.31
|
|
