|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.22
|
|
|
Service Code
|
NDC 8065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$55.21
|
| Rate for Payer: ASR ASR |
$144.74
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: BCBS Trust/PPO |
$123.03
|
| Rate for Payer: BCN Commercial |
$123.03
|
| 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: MI Amish Medical Board Commercial |
$119.38
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.31
|
|
|
SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$351.45
|
|
|
Service Code
|
NDC 60267031110
|
| Hospital Charge Code |
24049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.04 |
| Max. Negotiated Rate |
$351.45 |
| Rate for Payer: Aetna Commercial |
$316.31
|
| Rate for Payer: Aetna Medicare |
$130.04
|
| Rate for Payer: ASR ASR |
$340.91
|
| Rate for Payer: BCBS Complete |
$140.58
|
| Rate for Payer: BCBS Trust/PPO |
$289.77
|
| Rate for Payer: BCN Commercial |
$289.77
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Commercial |
$330.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$340.91
|
| Rate for Payer: Healthscope Whirlpool |
$351.45
|
| Rate for Payer: Mclaren Commercial |
$316.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Nomi Health Commercial |
$288.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$307.94
|
| Rate for Payer: Priority Health Narrow Network |
$246.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.28
|
|
|
SODIUM NITRITE 30 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$351.45
|
|
|
Service Code
|
NDC 60267031110
|
| Hospital Charge Code |
24049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$263.59 |
| Max. Negotiated Rate |
$351.45 |
| Rate for Payer: Aetna Commercial |
$316.31
|
| Rate for Payer: ASR ASR |
$340.91
|
| Rate for Payer: BCBS Trust/PPO |
$288.61
|
| Rate for Payer: BCN Commercial |
$288.61
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Commercial |
$330.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$340.91
|
| Rate for Payer: Healthscope Whirlpool |
$351.45
|
| Rate for Payer: Mclaren Commercial |
$316.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: Nomi Health Commercial |
$288.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.28
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
OP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$699.28 |
| Rate for Payer: Aetna Commercial |
$629.35
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$678.30
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$576.56
|
| Rate for Payer: BCN Commercial |
$576.56
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$657.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$678.30
|
| Rate for Payer: Healthscope Whirlpool |
$699.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$629.35
|
| Rate for Payer: Mclaren Medicaid |
$2.17
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$573.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.00
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$2.17
|
|
|
SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN
|
Facility
|
IP
|
$699.28
|
|
|
Service Code
|
HCPCS J0211
|
| Hospital Charge Code |
152373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$524.46 |
| Max. Negotiated Rate |
$699.28 |
| Rate for Payer: Aetna Commercial |
$629.35
|
| Rate for Payer: ASR ASR |
$678.30
|
| Rate for Payer: BCBS Trust/PPO |
$574.25
|
| Rate for Payer: BCN Commercial |
$574.25
|
| Rate for Payer: Cash Price |
$559.42
|
| Rate for Payer: Cofinity Commercial |
$657.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.42
|
| Rate for Payer: Healthscope Commercial |
$678.30
|
| Rate for Payer: Healthscope Whirlpool |
$699.28
|
| Rate for Payer: Mclaren Commercial |
$629.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.39
|
| Rate for Payer: Nomi Health Commercial |
$573.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.37
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$55.40
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$49.86
|
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: ASR ASR |
$53.74
|
| Rate for Payer: BCBS Complete |
$22.16
|
| Rate for Payer: BCBS Trust/PPO |
$45.68
|
| Rate for Payer: BCN Commercial |
$45.68
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$52.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.32
|
| Rate for Payer: Healthscope Commercial |
$53.74
|
| Rate for Payer: Healthscope Whirlpool |
$55.40
|
| Rate for Payer: Mclaren Commercial |
$49.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.09
|
| Rate for Payer: Nomi Health Commercial |
$45.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.54
|
| Rate for Payer: Priority Health Narrow Network |
$38.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.75
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$77.07
|
|
|
Service Code
|
NDC 71839012001
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: ASR ASR |
$74.76
|
| Rate for Payer: BCBS Trust/PPO |
$63.29
|
| Rate for Payer: BCN Commercial |
$63.29
|
| 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 |
$74.76
|
| Rate for Payer: Healthscope Whirlpool |
$77.07
|
| Rate for Payer: Mclaren Commercial |
$69.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.51
|
| Rate for Payer: Nomi Health Commercial |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.83
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.66
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.70
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: BCBS Complete |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$40.95
|
| Rate for Payer: BCN Commercial |
$40.95
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.66
|
| Rate for Payer: Mclaren Commercial |
$44.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.51
|
| Rate for Payer: Priority Health Narrow Network |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$264.12
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$264.12 |
| Rate for Payer: Aetna Commercial |
$237.71
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: ASR ASR |
$256.20
|
| Rate for Payer: BCBS Complete |
$105.65
|
| Rate for Payer: BCBS Trust/PPO |
$217.77
|
| Rate for Payer: BCN Commercial |
$217.77
|
| 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 |
$256.20
|
| Rate for Payer: Healthscope Whirlpool |
$264.12
|
| Rate for Payer: Mclaren Commercial |
$237.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.50
|
| Rate for Payer: Nomi Health Commercial |
$216.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.42
|
| Rate for Payer: Priority Health Narrow Network |
$185.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.43
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$77.07
|
|
|
Service Code
|
NDC 71839012001
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: ASR ASR |
$74.76
|
| Rate for Payer: BCBS Complete |
$30.83
|
| Rate for Payer: BCBS Trust/PPO |
$63.55
|
| Rate for Payer: BCN Commercial |
$63.55
|
| 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 |
$74.76
|
| Rate for Payer: Healthscope Whirlpool |
$77.07
|
| Rate for Payer: Mclaren Commercial |
$69.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.51
|
| Rate for Payer: Nomi Health Commercial |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.53
|
| Rate for Payer: Priority Health Narrow Network |
$54.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.83
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.40
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$49.86
|
| Rate for Payer: ASR ASR |
$53.74
|
| Rate for Payer: BCBS Trust/PPO |
$45.50
|
| Rate for Payer: BCN Commercial |
$45.50
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Cofinity Commercial |
$52.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.32
|
| Rate for Payer: Healthscope Commercial |
$53.74
|
| Rate for Payer: Healthscope Whirlpool |
$55.40
|
| Rate for Payer: Mclaren Commercial |
$49.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.09
|
| Rate for Payer: Nomi Health Commercial |
$45.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.75
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$264.12
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.09 |
| 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 |
$216.90
|
| Rate for Payer: BCN Commercial |
$216.90
|
| 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 |
$256.20
|
| Rate for Payer: Healthscope Whirlpool |
$264.12
|
| Rate for Payer: Mclaren Commercial |
$237.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.50
|
| Rate for Payer: Nomi Health Commercial |
$216.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.43
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.66
|
|
|
Service Code
|
NDC 72485010501
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.70
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.78
|
| Rate for Payer: BCN Commercial |
$40.78
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.66
|
| Rate for Payer: Mclaren Commercial |
$44.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$62.43
|
|
|
Service Code
|
NDC 42571026575
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.83 |
| 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 |
$51.27
|
| Rate for Payer: BCN Commercial |
$51.27
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cofinity Commercial |
$58.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.95
|
| Rate for Payer: Healthscope Commercial |
$60.56
|
| Rate for Payer: Healthscope Whirlpool |
$62.43
|
| Rate for Payer: Mclaren Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.07
|
| Rate for Payer: Nomi Health Commercial |
$51.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.94
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$62.43
|
|
|
Service Code
|
NDC 42571026575
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: ASR ASR |
$60.56
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.48
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cofinity Commercial |
$58.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.95
|
| Rate for Payer: Healthscope Commercial |
$60.56
|
| Rate for Payer: Healthscope Whirlpool |
$62.43
|
| Rate for Payer: Mclaren Commercial |
$56.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.07
|
| Rate for Payer: Nomi Health Commercial |
$51.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.70
|
| Rate for Payer: Priority Health Narrow Network |
$43.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.94
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.75 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: ASR ASR |
$229.89
|
| Rate for Payer: BCBS Trust/PPO |
$194.62
|
| Rate for Payer: BCN Commercial |
$194.62
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$222.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$229.89
|
| Rate for Payer: Healthscope Whirlpool |
$237.00
|
| Rate for Payer: Mclaren Commercial |
$213.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.56
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.75 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: ASR ASR |
$229.89
|
| Rate for Payer: BCBS Trust/PPO |
$194.62
|
| Rate for Payer: BCN Commercial |
$194.62
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$222.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$229.89
|
| Rate for Payer: Healthscope Whirlpool |
$237.00
|
| Rate for Payer: Mclaren Commercial |
$213.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.56
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Medicare |
$87.69
|
| Rate for Payer: ASR ASR |
$229.89
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$195.41
|
| Rate for Payer: BCN Commercial |
$195.41
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$222.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$229.89
|
| Rate for Payer: Healthscope Whirlpool |
$237.00
|
| Rate for Payer: Mclaren Commercial |
$213.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Nomi Health Commercial |
$194.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$207.66
|
| Rate for Payer: Priority Health Narrow Network |
$166.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.56
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$286.38 |
| Rate for Payer: Aetna Commercial |
$257.74
|
| Rate for Payer: Aetna Medicare |
$105.96
|
| Rate for Payer: ASR ASR |
$277.79
|
| Rate for Payer: BCBS Complete |
$114.55
|
| Rate for Payer: BCBS Trust/PPO |
$236.12
|
| Rate for Payer: BCN Commercial |
$236.12
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Healthscope Whirlpool |
$286.38
|
| Rate for Payer: Mclaren Commercial |
$257.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.93
|
| Rate for Payer: Priority Health Narrow Network |
$200.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.01
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$286.38
|
|
|
Service Code
|
NDC 409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$286.38 |
| Rate for Payer: Aetna Commercial |
$257.74
|
| Rate for Payer: Aetna Medicare |
$105.96
|
| Rate for Payer: ASR ASR |
$277.79
|
| Rate for Payer: BCBS Complete |
$114.55
|
| Rate for Payer: BCBS Trust/PPO |
$236.12
|
| Rate for Payer: BCN Commercial |
$236.12
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Healthscope Whirlpool |
$286.38
|
| Rate for Payer: Mclaren Commercial |
$257.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.93
|
| Rate for Payer: Priority Health Narrow Network |
$200.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.01
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.11
|
|
|
Service Code
|
NDC 63323088401
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$94.11 |
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Medicare |
$34.82
|
| Rate for Payer: ASR ASR |
$91.28
|
| Rate for Payer: BCBS Complete |
$37.64
|
| Rate for Payer: BCBS Trust/PPO |
$77.59
|
| Rate for Payer: BCN Commercial |
$77.59
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cofinity Commercial |
$88.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.28
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.11
|
| Rate for Payer: Mclaren Commercial |
$84.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.99
|
| Rate for Payer: Nomi Health Commercial |
$77.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.45
|
| Rate for Payer: Priority Health Narrow Network |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.81
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.11
|
|
|
Service Code
|
NDC 63323088401
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.58 |
| Max. Negotiated Rate |
$94.11 |
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: ASR ASR |
$91.28
|
| Rate for Payer: BCBS Trust/PPO |
$77.28
|
| Rate for Payer: BCN Commercial |
$77.28
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cofinity Commercial |
$88.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.28
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.11
|
| Rate for Payer: Mclaren Commercial |
$84.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.99
|
| Rate for Payer: Nomi Health Commercial |
$77.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.81
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.11
|
|
|
Service Code
|
NDC 63323088406
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$94.11 |
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Medicare |
$34.82
|
| Rate for Payer: ASR ASR |
$91.28
|
| Rate for Payer: BCBS Complete |
$37.64
|
| Rate for Payer: BCBS Trust/PPO |
$77.59
|
| Rate for Payer: BCN Commercial |
$77.59
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cofinity Commercial |
$88.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.28
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.11
|
| Rate for Payer: Mclaren Commercial |
$84.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.99
|
| Rate for Payer: Nomi Health Commercial |
$77.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.45
|
| Rate for Payer: Priority Health Narrow Network |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.81
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.78 |
| Max. Negotiated Rate |
$286.38 |
| Rate for Payer: Aetna Commercial |
$257.74
|
| Rate for Payer: ASR ASR |
$277.79
|
| Rate for Payer: BCBS Trust/PPO |
$235.18
|
| Rate for Payer: BCN Commercial |
$235.18
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Healthscope Whirlpool |
$286.38
|
| Rate for Payer: Mclaren Commercial |
$257.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.01
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$286.38
|
|
|
Service Code
|
NDC 409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.78 |
| Max. Negotiated Rate |
$286.38 |
| Rate for Payer: Aetna Commercial |
$257.74
|
| Rate for Payer: ASR ASR |
$277.79
|
| Rate for Payer: BCBS Trust/PPO |
$235.18
|
| Rate for Payer: BCN Commercial |
$235.18
|
| Rate for Payer: Cash Price |
$229.10
|
| Rate for Payer: Cofinity Commercial |
$269.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Healthscope Whirlpool |
$286.38
|
| Rate for Payer: Mclaren Commercial |
$257.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.42
|
| Rate for Payer: Nomi Health Commercial |
$234.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.01
|
|
