|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
NDC 00904632078
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: ASR Commercial |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$25.47
|
| 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: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$15.63
|
|
|
Service Code
|
NDC 96295012751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna Commercial |
$14.07
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: ASR ASR |
$15.16
|
| Rate for Payer: ASR Commercial |
$15.16
|
| Rate for Payer: BCBS Complete |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| 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: Priority Health HMO/PPO/Tiered Network |
$13.70
|
| Rate for Payer: Priority Health Narrow Network |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
NDC 00536741551
|
| 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
|
IP
|
$31.25
|
|
|
Service Code
|
NDC 00536741551
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: ASR Commercial |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$25.47
|
| 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: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
|
IP
|
$34.38
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: ASR ASR |
$33.35
|
| Rate for Payer: ASR Commercial |
$33.35
|
| Rate for Payer: BCBS Trust/PPO |
$28.02
|
| 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: UHC All Payor (Choice/PPO) + Core |
$30.25
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$40.33 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: ASR Commercial |
$39.12
|
| Rate for Payer: BCBS Complete |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$33.03
|
| Rate for Payer: BCN Commercial |
$31.27
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$40.33
|
| Rate for Payer: Healthscope Whirlpool |
$39.12
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.34
|
| Rate for Payer: Priority Health Narrow Network |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$40.33 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: ASR Commercial |
$39.12
|
| Rate for Payer: BCBS Trust/PPO |
$32.86
|
| Rate for Payer: BCN Commercial |
$31.27
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$40.33
|
| Rate for Payer: Healthscope Whirlpool |
$39.12
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$672.04
|
|
|
Service Code
|
NDC 46287000601
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.82 |
| Max. Negotiated Rate |
$672.04 |
| Rate for Payer: Aetna Commercial |
$604.84
|
| Rate for Payer: Aetna Medicare |
$336.02
|
| Rate for Payer: ASR ASR |
$651.88
|
| Rate for Payer: ASR Commercial |
$651.88
|
| Rate for Payer: BCBS Complete |
$268.82
|
| Rate for Payer: BCBS Trust/PPO |
$550.33
|
| Rate for Payer: BCN Commercial |
$521.03
|
| Rate for Payer: Cash Price |
$537.63
|
| Rate for Payer: Cofinity Commercial |
$631.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.63
|
| Rate for Payer: Healthscope Commercial |
$672.04
|
| Rate for Payer: Healthscope Whirlpool |
$651.88
|
| Rate for Payer: Mclaren Commercial |
$604.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.23
|
| Rate for Payer: Nomi Health Commercial |
$551.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$588.84
|
| Rate for Payer: Priority Health Narrow Network |
$471.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.40
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$83.03 |
| Rate for Payer: Aetna Commercial |
$74.73
|
| Rate for Payer: ASR ASR |
$80.54
|
| Rate for Payer: ASR Commercial |
$80.54
|
| Rate for Payer: BCBS Trust/PPO |
$67.66
|
| Rate for Payer: BCN Commercial |
$64.37
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Commercial |
$78.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$83.03
|
| Rate for Payer: Healthscope Whirlpool |
$80.54
|
| Rate for Payer: Mclaren Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: Nomi Health Commercial |
$68.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.07
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$83.03
|
|
|
Service Code
|
NDC 46287000660
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$83.03 |
| Rate for Payer: Aetna Commercial |
$74.73
|
| Rate for Payer: Aetna Medicare |
$41.52
|
| Rate for Payer: ASR ASR |
$80.54
|
| Rate for Payer: ASR Commercial |
$80.54
|
| Rate for Payer: BCBS Complete |
$33.21
|
| Rate for Payer: BCBS Trust/PPO |
$67.99
|
| Rate for Payer: BCN Commercial |
$64.37
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Cofinity Commercial |
$78.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$83.03
|
| Rate for Payer: Healthscope Whirlpool |
$80.54
|
| Rate for Payer: Mclaren Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.58
|
| Rate for Payer: Nomi Health Commercial |
$68.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.75
|
| Rate for Payer: Priority Health Narrow Network |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.07
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
NDC 09900001122
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: ASR ASR |
$8.40
|
| Rate for Payer: ASR Commercial |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.06
|
| Rate for Payer: BCN Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$8.66
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.36
|
| Rate for Payer: Nomi Health Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.62
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
NDC 09900001122
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: ASR ASR |
$8.40
|
| Rate for Payer: ASR Commercial |
$8.40
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$8.66
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.36
|
| Rate for Payer: Nomi Health Commercial |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.59
|
| Rate for Payer: Priority Health Narrow Network |
$6.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.62
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
|
IP
|
$672.04
|
|
|
Service Code
|
NDC 46287000601
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.83 |
| Max. Negotiated Rate |
$672.04 |
| Rate for Payer: Aetna Commercial |
$604.84
|
| Rate for Payer: ASR ASR |
$651.88
|
| Rate for Payer: ASR Commercial |
$651.88
|
| Rate for Payer: BCBS Trust/PPO |
$547.65
|
| Rate for Payer: BCN Commercial |
$521.03
|
| Rate for Payer: Cash Price |
$537.63
|
| Rate for Payer: Cofinity Commercial |
$631.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.63
|
| Rate for Payer: Healthscope Commercial |
$672.04
|
| Rate for Payer: Healthscope Whirlpool |
$651.88
|
| Rate for Payer: Mclaren Commercial |
$604.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.23
|
| Rate for Payer: Nomi Health Commercial |
$551.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.40
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$78.07
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$78.07 |
| Rate for Payer: Aetna Commercial |
$70.26
|
| Rate for Payer: ASR ASR |
$75.73
|
| Rate for Payer: ASR Commercial |
$75.73
|
| Rate for Payer: BCBS Trust/PPO |
$63.62
|
| Rate for Payer: BCN Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$73.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.46
|
| Rate for Payer: Healthscope Commercial |
$78.07
|
| Rate for Payer: Healthscope Whirlpool |
$75.73
|
| Rate for Payer: Mclaren Commercial |
$70.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.36
|
| Rate for Payer: Nomi Health Commercial |
$64.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.70
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$858.69
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.48 |
| Max. Negotiated Rate |
$858.69 |
| Rate for Payer: Aetna Commercial |
$772.82
|
| Rate for Payer: Aetna Medicare |
$429.34
|
| Rate for Payer: ASR ASR |
$832.93
|
| Rate for Payer: ASR Commercial |
$832.93
|
| Rate for Payer: BCBS Complete |
$343.48
|
| Rate for Payer: BCBS Trust/PPO |
$703.18
|
| Rate for Payer: BCN Commercial |
$665.74
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cofinity Commercial |
$807.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.95
|
| Rate for Payer: Healthscope Commercial |
$858.69
|
| Rate for Payer: Healthscope Whirlpool |
$832.93
|
| Rate for Payer: Mclaren Commercial |
$772.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.89
|
| Rate for Payer: Nomi Health Commercial |
$704.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.38
|
| Rate for Payer: Priority Health Narrow Network |
$601.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.65
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$858.69
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$558.15 |
| Max. Negotiated Rate |
$858.69 |
| Rate for Payer: Aetna Commercial |
$772.82
|
| Rate for Payer: ASR ASR |
$832.93
|
| Rate for Payer: ASR Commercial |
$832.93
|
| Rate for Payer: BCBS Trust/PPO |
$699.75
|
| Rate for Payer: BCN Commercial |
$665.74
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cofinity Commercial |
$807.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.95
|
| Rate for Payer: Healthscope Commercial |
$858.69
|
| Rate for Payer: Healthscope Whirlpool |
$832.93
|
| Rate for Payer: Mclaren Commercial |
$772.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.89
|
| Rate for Payer: Nomi Health Commercial |
$704.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.65
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$78.07
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$78.07 |
| Rate for Payer: Aetna Commercial |
$70.26
|
| Rate for Payer: Aetna Medicare |
$39.04
|
| Rate for Payer: ASR ASR |
$75.73
|
| Rate for Payer: ASR Commercial |
$75.73
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.93
|
| Rate for Payer: BCN Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$73.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.46
|
| Rate for Payer: Healthscope Commercial |
$78.07
|
| Rate for Payer: Healthscope Whirlpool |
$75.73
|
| Rate for Payer: Mclaren Commercial |
$70.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.36
|
| Rate for Payer: Nomi Health Commercial |
$64.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.70
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Commercial |
$109.98
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: ASR ASR |
$118.53
|
| Rate for Payer: ASR Commercial |
$118.53
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS Trust/PPO |
$100.07
|
| Rate for Payer: BCN Commercial |
$94.74
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$122.20
|
| Rate for Payer: Healthscope Whirlpool |
$118.53
|
| Rate for Payer: Mclaren Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.07
|
| Rate for Payer: Priority Health Narrow Network |
$85.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.54
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 00245001289
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: ASR ASR |
$4.31
|
| Rate for Payer: ASR Commercial |
$4.31
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.64
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Healthscope Whirlpool |
$4.31
|
| Rate for Payer: Mclaren Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.89
|
| Rate for Payer: Priority Health Narrow Network |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.91
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.60 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: ASR ASR |
$430.68
|
| Rate for Payer: ASR Commercial |
$430.68
|
| Rate for Payer: BCBS Trust/PPO |
$361.82
|
| Rate for Payer: BCN Commercial |
$344.23
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$417.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$444.00
|
| Rate for Payer: Healthscope Whirlpool |
$430.68
|
| Rate for Payer: Mclaren Commercial |
$399.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: Nomi Health Commercial |
$364.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.72
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 00245001289
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: ASR ASR |
$4.31
|
| Rate for Payer: ASR Commercial |
$4.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Healthscope Whirlpool |
$4.31
|
| Rate for Payer: Mclaren Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.91
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: Aetna Medicare |
$222.00
|
| Rate for Payer: ASR ASR |
$430.68
|
| Rate for Payer: ASR Commercial |
$430.68
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS Trust/PPO |
$363.59
|
| Rate for Payer: BCN Commercial |
$344.23
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$417.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$444.00
|
| Rate for Payer: Healthscope Whirlpool |
$430.68
|
| Rate for Payer: Mclaren Commercial |
$399.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: Nomi Health Commercial |
$364.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.03
|
| Rate for Payer: Priority Health Narrow Network |
$311.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.72
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Commercial |
$109.98
|
| Rate for Payer: ASR ASR |
$118.53
|
| Rate for Payer: ASR Commercial |
$118.53
|
| Rate for Payer: BCBS Trust/PPO |
$99.58
|
| Rate for Payer: BCN Commercial |
$94.74
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$122.20
|
| Rate for Payer: Healthscope Whirlpool |
$118.53
|
| Rate for Payer: Mclaren Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.54
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$1,051.71
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.44
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$469.95
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: ASR Commercial |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.01
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| Rate for Payer: Mclaren Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
