|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 00409662535
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: ASR Commercial |
$34.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.01
|
| Rate for Payer: BCN Commercial |
$27.60
|
| 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 |
$35.60
|
| Rate for Payer: Healthscope Whirlpool |
$34.53
|
| 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: Priority Health Cigna Priority Health |
$23.14
|
| 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 00409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: ASR Commercial |
$34.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.01
|
| Rate for Payer: BCN Commercial |
$27.60
|
| 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 |
$35.60
|
| Rate for Payer: Healthscope Whirlpool |
$34.53
|
| 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: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.33
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.94
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna Commercial |
$35.05
|
| Rate for Payer: Aetna Medicare |
$19.47
|
| Rate for Payer: ASR ASR |
$37.77
|
| Rate for Payer: ASR Commercial |
$37.77
|
| Rate for Payer: BCBS Complete |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.89
|
| Rate for Payer: BCN Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$36.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.15
|
| Rate for Payer: Healthscope Commercial |
$38.94
|
| Rate for Payer: Healthscope Whirlpool |
$37.77
|
| Rate for Payer: Mclaren Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.10
|
| Rate for Payer: Nomi Health Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.12
|
| Rate for Payer: Priority Health Narrow Network |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.27
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.94
|
|
|
Service Code
|
NDC 51754500101
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna Commercial |
$35.05
|
| Rate for Payer: ASR ASR |
$37.77
|
| Rate for Payer: ASR Commercial |
$37.77
|
| Rate for Payer: BCBS Trust/PPO |
$31.73
|
| Rate for Payer: BCN Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$36.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.15
|
| Rate for Payer: Healthscope Commercial |
$38.94
|
| Rate for Payer: Healthscope Whirlpool |
$37.77
|
| Rate for Payer: Mclaren Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.10
|
| Rate for Payer: Nomi Health Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.27
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43.39
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$43.39 |
| Rate for Payer: Aetna Commercial |
$39.05
|
| Rate for Payer: Aetna Medicare |
$21.70
|
| Rate for Payer: ASR ASR |
$42.09
|
| Rate for Payer: ASR Commercial |
$42.09
|
| Rate for Payer: BCBS Complete |
$17.36
|
| Rate for Payer: BCBS Trust/PPO |
$35.53
|
| Rate for Payer: BCN Commercial |
$33.64
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Commercial |
$40.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$43.39
|
| Rate for Payer: Healthscope Whirlpool |
$42.09
|
| Rate for Payer: Mclaren Commercial |
$39.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.88
|
| Rate for Payer: Nomi Health Commercial |
$35.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.02
|
| Rate for Payer: Priority Health Narrow Network |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.18
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$43.39
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$43.39 |
| Rate for Payer: Aetna Commercial |
$39.05
|
| Rate for Payer: ASR ASR |
$42.09
|
| Rate for Payer: ASR Commercial |
$42.09
|
| Rate for Payer: BCBS Trust/PPO |
$35.36
|
| Rate for Payer: BCN Commercial |
$33.64
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Commercial |
$40.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$43.39
|
| Rate for Payer: Healthscope Whirlpool |
$42.09
|
| Rate for Payer: Mclaren Commercial |
$39.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.88
|
| Rate for Payer: Nomi Health Commercial |
$35.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.18
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 77333083110
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: ASR Commercial |
$268.98
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: BCBS Trust/PPO |
$227.08
|
| Rate for Payer: BCN Commercial |
$214.99
|
| 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 |
$277.30
|
| Rate for Payer: Healthscope Whirlpool |
$268.98
|
| 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: Priority Health Cigna Priority Health |
$180.25
|
| Rate for Payer: 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 |
$1.11 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: ASR Commercial |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Healthscope Whirlpool |
$2.69
|
| Rate for Payer: Mclaren Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: Nomi Health Commercial |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: 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 00223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna Medicare |
$79.90
|
| Rate for Payer: ASR ASR |
$155.01
|
| Rate for Payer: ASR Commercial |
$155.01
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$130.86
|
| Rate for Payer: BCN Commercial |
$123.89
|
| 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 |
$159.80
|
| Rate for Payer: Healthscope Whirlpool |
$155.01
|
| 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: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: 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 650 MG TABLET
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 77333083125
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: ASR Commercial |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Healthscope Whirlpool |
$2.69
|
| Rate for Payer: Mclaren Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: Nomi Health Commercial |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 00223172101
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: ASR ASR |
$155.01
|
| Rate for Payer: ASR Commercial |
$155.01
|
| Rate for Payer: BCBS Trust/PPO |
$130.22
|
| Rate for Payer: BCN Commercial |
$123.89
|
| 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 |
$159.80
|
| Rate for Payer: Healthscope Whirlpool |
$155.01
|
| 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: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.62
|
|
|
SODIUM BICARBONATE 650 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 77333083110
|
| Hospital Charge Code |
7312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: ASR Commercial |
$268.98
|
| Rate for Payer: BCBS Trust/PPO |
$225.97
|
| Rate for Payer: BCN Commercial |
$214.99
|
| 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 |
$277.30
|
| Rate for Payer: Healthscope Whirlpool |
$268.98
|
| 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: Priority Health Cigna Priority Health |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: ASR Commercial |
$65.17
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$55.02
|
| Rate for Payer: BCN Commercial |
$52.09
|
| Rate for Payer: Cash Price |
$53.76
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.19
|
| Rate for Payer: Healthscope Whirlpool |
$65.17
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.87
|
| Rate for Payer: Priority Health Narrow Network |
$47.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.13
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
NDC 76329335201
|
| Hospital Charge Code |
7309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna Commercial |
$60.47
|
| Rate for Payer: ASR ASR |
$65.17
|
| Rate for Payer: ASR Commercial |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$54.75
|
| Rate for Payer: BCN Commercial |
$52.09
|
| Rate for Payer: Cash Price |
$53.76
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$67.19
|
| Rate for Payer: Healthscope Whirlpool |
$65.17
|
| Rate for Payer: Mclaren Commercial |
$60.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Nomi Health Commercial |
$55.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.13
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$51.84
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: ASR ASR |
$50.28
|
| Rate for Payer: ASR Commercial |
$50.28
|
| Rate for Payer: BCBS Complete |
$20.74
|
| Rate for Payer: BCBS Trust/PPO |
$42.45
|
| Rate for Payer: BCN Commercial |
$40.19
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$51.84
|
| Rate for Payer: Healthscope Whirlpool |
$50.28
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.42
|
| Rate for Payer: Priority Health Narrow Network |
$36.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.62
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
OP
|
$51.84
|
|
|
Service Code
|
NDC 10119000738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: ASR ASR |
$50.28
|
| Rate for Payer: ASR Commercial |
$50.28
|
| Rate for Payer: BCBS Complete |
$20.74
|
| Rate for Payer: BCBS Trust/PPO |
$42.45
|
| Rate for Payer: BCN Commercial |
$40.19
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$51.84
|
| Rate for Payer: Healthscope Whirlpool |
$50.28
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.42
|
| Rate for Payer: Priority Health Narrow Network |
$36.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.62
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$51.84
|
|
|
Service Code
|
NDC 10119000738
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: ASR ASR |
$50.28
|
| Rate for Payer: ASR Commercial |
$50.28
|
| Rate for Payer: BCBS Trust/PPO |
$42.24
|
| Rate for Payer: BCN Commercial |
$40.19
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$51.84
|
| Rate for Payer: Healthscope Whirlpool |
$50.28
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.62
|
|
|
SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN
|
Facility
|
IP
|
$51.84
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
165406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: ASR ASR |
$50.28
|
| Rate for Payer: ASR Commercial |
$50.28
|
| Rate for Payer: BCBS Trust/PPO |
$42.24
|
| Rate for Payer: BCN Commercial |
$40.19
|
| Rate for Payer: Cash Price |
$41.47
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.47
|
| Rate for Payer: Healthscope Commercial |
$51.84
|
| Rate for Payer: Healthscope Whirlpool |
$50.28
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$42.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.62
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: 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 0.45 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338004304
|
| Hospital Charge Code |
7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.21
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Aetna Commercial |
$5.59
|
| Rate for Payer: Aetna Medicare |
$3.10
|
| Rate for Payer: ASR ASR |
$6.02
|
| Rate for Payer: ASR Commercial |
$6.02
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$5.09
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.97
|
| Rate for Payer: Healthscope Commercial |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$6.02
|
| Rate for Payer: Mclaren Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.28
|
| Rate for Payer: Nomi Health Commercial |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.44
|
| Rate for Payer: Priority Health Narrow Network |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.46
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: ASR ASR |
$5.12
|
| Rate for Payer: ASR Commercial |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$5.28
|
| Rate for Payer: Healthscope Whirlpool |
$5.12
|
| Rate for Payer: Mclaren Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.65
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$2.64
|
| Rate for Payer: ASR ASR |
$5.12
|
| Rate for Payer: ASR Commercial |
$5.12
|
| Rate for Payer: BCBS Complete |
$2.11
|
| Rate for Payer: BCBS Trust/PPO |
$4.32
|
| Rate for Payer: BCN Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$5.28
|
| Rate for Payer: Healthscope Whirlpool |
$5.12
|
| Rate for Payer: Mclaren Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.63
|
| Rate for Payer: Priority Health Narrow Network |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.65
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
OP
|
$6.86
|
|
|
Service Code
|
NDC 00536250676
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Aetna Medicare |
$3.43
|
| Rate for Payer: ASR ASR |
$6.65
|
| Rate for Payer: ASR Commercial |
$6.65
|
| Rate for Payer: BCBS Complete |
$2.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.62
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cofinity Commercial |
$6.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.49
|
| Rate for Payer: Healthscope Commercial |
$6.86
|
| Rate for Payer: Healthscope Whirlpool |
$6.65
|
| Rate for Payer: Mclaren Commercial |
$6.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.83
|
| Rate for Payer: Nomi Health Commercial |
$5.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.04
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL
|
Facility
|
IP
|
$6.21
|
|
|
Service Code
|
NDC 45802035758
|
| Hospital Charge Code |
29676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Aetna Commercial |
$5.59
|
| Rate for Payer: ASR ASR |
$6.02
|
| Rate for Payer: ASR Commercial |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$5.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.97
|
| Rate for Payer: Healthscope Commercial |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$6.02
|
| Rate for Payer: Mclaren Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.28
|
| Rate for Payer: Nomi Health Commercial |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.46
|
|
