|
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 |
$32.28 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.47
|
| Rate for Payer: BCN Commercial |
$38.50
|
| 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 |
$49.66
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
|
|
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 |
$30.83 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$38.54
|
| Rate for Payer: ASR ASR |
$74.76
|
| Rate for Payer: ASR Commercial |
$74.76
|
| Rate for Payer: BCBS Complete |
$30.83
|
| Rate for Payer: BCBS Trust/PPO |
$63.11
|
| Rate for Payer: BCN Commercial |
$59.75
|
| 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 |
$77.07
|
| Rate for Payer: Healthscope Whirlpool |
$74.76
|
| Rate for Payer: Mclaren Commercial |
$69.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.51
|
| Rate for Payer: Nomi Health Commercial |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.10
|
| Rate for Payer: 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 |
$67.82
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.92
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: Aetna Medicare |
$22.96
|
| Rate for Payer: ASR ASR |
$44.54
|
| Rate for Payer: ASR Commercial |
$44.54
|
| Rate for Payer: BCBS Complete |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$37.60
|
| Rate for Payer: BCN Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$45.92
|
| Rate for Payer: Healthscope Whirlpool |
$44.54
|
| Rate for Payer: Mclaren Commercial |
$41.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.03
|
| Rate for Payer: Nomi Health Commercial |
$37.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.24
|
| Rate for Payer: Priority Health Narrow Network |
$32.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.41
|
|
|
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 |
$40.58 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: ASR ASR |
$60.56
|
| Rate for Payer: ASR Commercial |
$60.56
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cofinity Commercial |
$58.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.43
|
| Rate for Payer: Healthscope Whirlpool |
$60.56
|
| Rate for Payer: Mclaren Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.07
|
| Rate for Payer: Nomi Health Commercial |
$51.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.94
|
|
|
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 |
$105.65 |
| Max. Negotiated Rate |
$264.12 |
| Rate for Payer: Aetna Commercial |
$237.71
|
| Rate for Payer: Aetna Medicare |
$132.06
|
| Rate for Payer: ASR ASR |
$256.20
|
| Rate for Payer: ASR Commercial |
$256.20
|
| Rate for Payer: BCBS Complete |
$105.65
|
| Rate for Payer: BCBS Trust/PPO |
$216.29
|
| Rate for Payer: BCN Commercial |
$204.77
|
| 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 |
$264.12
|
| Rate for Payer: Healthscope Whirlpool |
$256.20
|
| 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: Priority Health Cigna Priority Health |
$171.68
|
| Rate for Payer: 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
|
IP
|
$264.12
|
|
|
Service Code
|
NDC 14789001202
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$264.12 |
| Rate for Payer: Aetna Commercial |
$237.71
|
| Rate for Payer: ASR ASR |
$256.20
|
| Rate for Payer: ASR Commercial |
$256.20
|
| Rate for Payer: BCBS Trust/PPO |
$215.23
|
| Rate for Payer: BCN Commercial |
$204.77
|
| 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 |
$264.12
|
| Rate for Payer: Healthscope Whirlpool |
$256.20
|
| 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: Priority Health Cigna Priority Health |
$171.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.43
|
|
|
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 |
$19.86 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR Commercial |
$48.17
|
| Rate for Payer: BCBS Complete |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$40.67
|
| Rate for Payer: BCN Commercial |
$38.50
|
| 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 |
$49.66
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.21
|
| Rate for Payer: Nomi Health Commercial |
$40.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.28
|
| Rate for Payer: 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
|
IP
|
$45.92
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
18908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Aetna Commercial |
$41.33
|
| Rate for Payer: ASR ASR |
$44.54
|
| Rate for Payer: ASR Commercial |
$44.54
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$45.92
|
| Rate for Payer: Healthscope Whirlpool |
$44.54
|
| Rate for Payer: Mclaren Commercial |
$41.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.03
|
| Rate for Payer: Nomi Health Commercial |
$37.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.41
|
|
|
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 |
$24.97 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Medicare |
$31.22
|
| Rate for Payer: ASR ASR |
$60.56
|
| Rate for Payer: ASR Commercial |
$60.56
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cofinity Commercial |
$58.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.43
|
| Rate for Payer: Healthscope Whirlpool |
$60.56
|
| Rate for Payer: Mclaren Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.07
|
| Rate for Payer: Nomi Health Commercial |
$51.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.70
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.94
|
|
|
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 |
$50.10 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: ASR ASR |
$74.76
|
| Rate for Payer: ASR Commercial |
$74.76
|
| Rate for Payer: BCBS Trust/PPO |
$62.80
|
| Rate for Payer: BCN Commercial |
$59.75
|
| 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 |
$77.07
|
| Rate for Payer: Healthscope Whirlpool |
$74.76
|
| Rate for Payer: Mclaren Commercial |
$69.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.51
|
| Rate for Payer: Nomi Health Commercial |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.82
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$111.70
|
|
|
Service Code
|
NDC 63323017005
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.68 |
| Max. Negotiated Rate |
$111.70 |
| Rate for Payer: Aetna Commercial |
$100.53
|
| Rate for Payer: Aetna Medicare |
$55.85
|
| Rate for Payer: ASR ASR |
$108.35
|
| Rate for Payer: ASR Commercial |
$108.35
|
| Rate for Payer: BCBS Complete |
$44.68
|
| Rate for Payer: BCBS Trust/PPO |
$91.47
|
| Rate for Payer: BCN Commercial |
$86.60
|
| Rate for Payer: Cash Price |
$89.36
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$111.70
|
| Rate for Payer: Healthscope Whirlpool |
$108.35
|
| Rate for Payer: Mclaren Commercial |
$100.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.94
|
| Rate for Payer: Nomi Health Commercial |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.87
|
| Rate for Payer: Priority Health Narrow Network |
$78.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.30
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$315.38
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna Commercial |
$283.84
|
| Rate for Payer: Aetna Medicare |
$157.69
|
| Rate for Payer: ASR ASR |
$305.92
|
| Rate for Payer: ASR Commercial |
$305.92
|
| Rate for Payer: BCBS Complete |
$126.15
|
| Rate for Payer: BCBS Trust/PPO |
$258.26
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cofinity Commercial |
$296.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.30
|
| Rate for Payer: Healthscope Commercial |
$315.38
|
| Rate for Payer: Healthscope Whirlpool |
$305.92
|
| Rate for Payer: Mclaren Commercial |
$283.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.07
|
| Rate for Payer: Nomi Health Commercial |
$258.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.34
|
| Rate for Payer: Priority Health Narrow Network |
$221.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.53
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.80
|
|
|
Service Code
|
NDC 63323017015
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$185.77 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Aetna Commercial |
$257.22
|
| Rate for Payer: ASR ASR |
$277.23
|
| Rate for Payer: ASR Commercial |
$277.23
|
| Rate for Payer: BCBS Trust/PPO |
$232.90
|
| Rate for Payer: BCN Commercial |
$221.58
|
| Rate for Payer: Cash Price |
$228.64
|
| Rate for Payer: Cofinity Commercial |
$268.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.64
|
| Rate for Payer: Healthscope Commercial |
$285.80
|
| Rate for Payer: Healthscope Whirlpool |
$277.23
|
| Rate for Payer: Mclaren Commercial |
$257.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.93
|
| Rate for Payer: Nomi Health Commercial |
$234.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.50
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: ASR Commercial |
$239.04
|
| Rate for Payer: BCBS Trust/PPO |
$200.82
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.38
|
|
|
Service Code
|
NDC 63323088101
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna Commercial |
$283.84
|
| Rate for Payer: ASR ASR |
$305.92
|
| Rate for Payer: ASR Commercial |
$305.92
|
| Rate for Payer: BCBS Trust/PPO |
$257.00
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cofinity Commercial |
$296.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.30
|
| Rate for Payer: Healthscope Commercial |
$315.38
|
| Rate for Payer: Healthscope Whirlpool |
$305.92
|
| Rate for Payer: Mclaren Commercial |
$283.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.07
|
| Rate for Payer: Nomi Health Commercial |
$258.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.53
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$315.38
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna Commercial |
$283.84
|
| Rate for Payer: Aetna Medicare |
$157.69
|
| Rate for Payer: ASR ASR |
$305.92
|
| Rate for Payer: ASR Commercial |
$305.92
|
| Rate for Payer: BCBS Complete |
$126.15
|
| Rate for Payer: BCBS Trust/PPO |
$258.26
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cofinity Commercial |
$296.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.30
|
| Rate for Payer: Healthscope Commercial |
$315.38
|
| Rate for Payer: Healthscope Whirlpool |
$305.92
|
| Rate for Payer: Mclaren Commercial |
$283.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.07
|
| Rate for Payer: Nomi Health Commercial |
$258.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.34
|
| Rate for Payer: Priority Health Narrow Network |
$221.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.53
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$315.38
|
|
|
Service Code
|
NDC 63323088116
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna Commercial |
$283.84
|
| Rate for Payer: ASR ASR |
$305.92
|
| Rate for Payer: ASR Commercial |
$305.92
|
| Rate for Payer: BCBS Trust/PPO |
$257.00
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cofinity Commercial |
$296.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.30
|
| Rate for Payer: Healthscope Commercial |
$315.38
|
| Rate for Payer: Healthscope Whirlpool |
$305.92
|
| Rate for Payer: Mclaren Commercial |
$283.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.07
|
| Rate for Payer: Nomi Health Commercial |
$258.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.53
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$285.80
|
|
|
Service Code
|
NDC 63323017015
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.32 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Aetna Commercial |
$257.22
|
| Rate for Payer: Aetna Medicare |
$142.90
|
| Rate for Payer: ASR ASR |
$277.23
|
| Rate for Payer: ASR Commercial |
$277.23
|
| Rate for Payer: BCBS Complete |
$114.32
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$221.58
|
| Rate for Payer: Cash Price |
$228.64
|
| Rate for Payer: Cofinity Commercial |
$268.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.64
|
| Rate for Payer: Healthscope Commercial |
$285.80
|
| Rate for Payer: Healthscope Whirlpool |
$277.23
|
| Rate for Payer: Mclaren Commercial |
$257.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.93
|
| Rate for Payer: Nomi Health Commercial |
$234.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.42
|
| Rate for Payer: Priority Health Narrow Network |
$200.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.50
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 00409739172
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.57 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: Aetna Medicare |
$123.22
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: ASR Commercial |
$239.04
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: BCBS Trust/PPO |
$201.80
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.92
|
| Rate for Payer: Priority Health Narrow Network |
$172.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$111.70
|
|
|
Service Code
|
NDC 63323017005
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$111.70 |
| Rate for Payer: Aetna Commercial |
$100.53
|
| Rate for Payer: ASR ASR |
$108.35
|
| Rate for Payer: ASR Commercial |
$108.35
|
| Rate for Payer: BCBS Trust/PPO |
$91.02
|
| Rate for Payer: BCN Commercial |
$86.60
|
| Rate for Payer: Cash Price |
$89.36
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$111.70
|
| Rate for Payer: Healthscope Whirlpool |
$108.35
|
| Rate for Payer: Mclaren Commercial |
$100.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.94
|
| Rate for Payer: Nomi Health Commercial |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.30
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.43
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.57 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: Aetna Medicare |
$123.22
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: ASR Commercial |
$239.04
|
| Rate for Payer: BCBS Complete |
$98.57
|
| Rate for Payer: BCBS Trust/PPO |
$201.80
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.92
|
| Rate for Payer: Priority Health Narrow Network |
$172.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.43
|
|
|
Service Code
|
NDC 00409739182
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: ASR Commercial |
$239.04
|
| Rate for Payer: BCBS Trust/PPO |
$200.82
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.47
|
| Rate for Payer: Nomi Health Commercial |
$202.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
NDC 00904632078
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: ASR Commercial |
$30.31
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$25.59
|
| Rate for Payer: BCN Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$31.25
|
| Rate for Payer: Healthscope Whirlpool |
$30.31
|
| Rate for Payer: Mclaren Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.56
|
| Rate for Payer: Nomi Health Commercial |
$25.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.38
|
| Rate for Payer: Priority Health Narrow Network |
$21.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$34.38
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Medicare |
$17.19
|
| Rate for Payer: ASR ASR |
$33.35
|
| Rate for Payer: ASR Commercial |
$33.35
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.15
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cofinity Commercial |
$32.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Healthscope Whirlpool |
$33.35
|
| Rate for Payer: Mclaren Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.22
|
| Rate for Payer: Nomi Health Commercial |
$28.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.12
|
| Rate for Payer: Priority Health Narrow Network |
$24.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.25
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna Commercial |
$14.07
|
| Rate for Payer: ASR ASR |
$15.16
|
| Rate for Payer: ASR Commercial |
$15.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$15.63
|
| Rate for Payer: Healthscope Whirlpool |
$15.16
|
| Rate for Payer: Mclaren Commercial |
$14.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.29
|
| Rate for Payer: Nomi Health Commercial |
$12.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
|
