|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.83
|
| Rate for Payer: Priority Health Narrow Network |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
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 |
$158.86 |
| Max. Negotiated Rate |
$397.15 |
| Rate for Payer: Aetna Commercial |
$357.44
|
| Rate for Payer: Aetna Medicare |
$198.58
|
| Rate for Payer: ASR ASR |
$385.24
|
| Rate for Payer: ASR Commercial |
$385.24
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: BCBS Trust/PPO |
$325.23
|
| Rate for Payer: BCN Commercial |
$307.91
|
| 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 |
$397.15
|
| Rate for Payer: Healthscope Whirlpool |
$385.24
|
| 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: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: 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 |
$1.59 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: ASR ASR |
$3.85
|
| Rate for Payer: ASR Commercial |
$3.85
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.08
|
| 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 |
$3.97
|
| Rate for Payer: Healthscope Whirlpool |
$3.85
|
| Rate for Payer: Mclaren Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.58
|
| Rate for Payer: 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 |
$3.49
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 77333084425
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 00223176001
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$220.90 |
| Rate for Payer: Aetna Commercial |
$198.81
|
| Rate for Payer: Aetna Medicare |
$110.45
|
| Rate for Payer: ASR ASR |
$214.27
|
| Rate for Payer: ASR Commercial |
$214.27
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: BCBS Trust/PPO |
$180.90
|
| Rate for Payer: BCN Commercial |
$171.26
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$207.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$220.90
|
| Rate for Payer: Healthscope Whirlpool |
$214.27
|
| Rate for Payer: Mclaren Commercial |
$198.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.55
|
| Rate for Payer: Priority Health Narrow Network |
$154.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.39
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: ASR Commercial |
$2.62
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.09
|
| 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 |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
SODIUM CHLORIDE 3 % FOR NEBULIZATION
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 00487900360
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: ASR ASR |
$2.62
|
| Rate for Payer: ASR Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.09
|
| 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 |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
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 |
$34.96 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: ASR Commercial |
$84.78
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$71.57
|
| Rate for Payer: BCN Commercial |
$67.76
|
| 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 |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| 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: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: 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
|
$87.40
|
|
|
Service Code
|
NDC 63323053075
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Aetna Medicare |
$43.70
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: ASR Commercial |
$84.78
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$71.57
|
| Rate for Payer: BCN Commercial |
$67.76
|
| 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 |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| 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: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: 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 00338005403
|
| Hospital Charge Code |
7321
|
|
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 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$87.40
|
|
|
Service Code
|
NDC 63323053075
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: ASR Commercial |
$84.78
|
| Rate for Payer: BCBS Trust/PPO |
$71.22
|
| Rate for Payer: BCN Commercial |
$67.76
|
| 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 |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| 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: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
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 |
$56.81 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: ASR ASR |
$84.78
|
| Rate for Payer: ASR Commercial |
$84.78
|
| Rate for Payer: BCBS Trust/PPO |
$71.22
|
| Rate for Payer: BCN Commercial |
$67.76
|
| 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 |
$87.40
|
| Rate for Payer: Healthscope Whirlpool |
$84.78
|
| 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: Priority Health Cigna Priority Health |
$56.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.91
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
7321
|
|
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-ALOE VERA NASAL SPRAY
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: ASR Commercial |
$25.16
|
| Rate for Payer: BCBS Trust/PPO |
$21.14
|
| Rate for Payer: BCN Commercial |
$20.11
|
| 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 |
$25.94
|
| Rate for Payer: Healthscope Whirlpool |
$25.16
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.83
|
|
|
SODIUM CHLORIDE-ALOE VERA NASAL SPRAY
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 00225052848
|
| Hospital Charge Code |
115264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: ASR ASR |
$25.16
|
| Rate for Payer: ASR Commercial |
$25.16
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$21.24
|
| Rate for Payer: BCN Commercial |
$20.11
|
| 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 |
$25.94
|
| Rate for Payer: Healthscope Whirlpool |
$25.16
|
| Rate for Payer: Mclaren Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: 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
|
IP
|
$46.35
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: ASR ASR |
$44.96
|
| Rate for Payer: ASR Commercial |
$44.96
|
| Rate for Payer: BCBS Trust/PPO |
$37.77
|
| Rate for Payer: BCN Commercial |
$35.94
|
| 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 |
$46.35
|
| Rate for Payer: Healthscope Whirlpool |
$44.96
|
| 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: Priority Health Cigna Priority Health |
$30.13
|
| 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
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: ASR ASR |
$17.81
|
| Rate for Payer: ASR Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$14.96
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Whirlpool |
$17.81
|
| Rate for Payer: Mclaren Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.16
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 00121059515
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: ASR ASR |
$17.81
|
| Rate for Payer: ASR Commercial |
$17.81
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Whirlpool |
$17.81
|
| Rate for Payer: Mclaren Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Nomi Health Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.09
|
| Rate for Payer: Priority Health Narrow Network |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.16
|
|
|
SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.35
|
|
|
Service Code
|
NDC 00121059516
|
| Hospital Charge Code |
15706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: ASR ASR |
$44.96
|
| Rate for Payer: ASR Commercial |
$44.96
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$35.94
|
| 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 |
$46.35
|
| Rate for Payer: Healthscope Whirlpool |
$44.96
|
| 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: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.61
|
| Rate for Payer: Priority Health Narrow Network |
$32.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.79
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$194.31
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
11067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.93
|
| Rate for Payer: Priority Health Narrow Network |
$167.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
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 |
$89.68 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.17
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: ASR Commercial |
$133.83
|
| Rate for Payer: BCBS Trust/PPO |
$112.43
|
| Rate for Payer: BCN Commercial |
$106.97
|
| 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 |
$137.97
|
| Rate for Payer: Healthscope Whirlpool |
$133.83
|
| Rate for Payer: Mclaren Commercial |
$124.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.41
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.17
|
| Rate for Payer: Aetna Medicare |
$68.98
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: ASR Commercial |
$133.83
|
| Rate for Payer: BCBS Complete |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$112.98
|
| Rate for Payer: BCN Commercial |
$106.97
|
| 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 |
$137.97
|
| Rate for Payer: Healthscope Whirlpool |
$133.83
|
| Rate for Payer: Mclaren Commercial |
$124.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.01
|
| Rate for Payer: Priority Health Narrow Network |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.41
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$149.22
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: ASR ASR |
$144.74
|
| Rate for Payer: ASR Commercial |
$144.74
|
| Rate for Payer: BCBS Trust/PPO |
$121.60
|
| Rate for Payer: BCN Commercial |
$115.69
|
| 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 |
$149.22
|
| Rate for Payer: Healthscope Whirlpool |
$144.74
|
| 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: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.31
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$149.22
|
|
|
Service Code
|
NDC 08065183055
|
| Hospital Charge Code |
28913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: ASR ASR |
$144.74
|
| Rate for Payer: ASR Commercial |
$144.74
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: BCBS Trust/PPO |
$122.20
|
| Rate for Payer: BCN Commercial |
$115.69
|
| 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 |
$149.22
|
| Rate for Payer: Healthscope Whirlpool |
$144.74
|
| 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: Priority Health Cigna Priority Health |
$96.99
|
| Rate for Payer: 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
|
|
