|
SODIUM CHLORIDE 0.9 % IV PGBK
|
Facility
OP
|
$53.20
|
|
|
Service Code
|
NDC 00338915930
|
| Hospital Charge Code |
117813
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$44.90
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$74.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Centivo All Commercial |
$27.13
|
| Rate for Payer: Cigna All Commercial |
$45.91
|
| Rate for Payer: CORVEL All Commercial |
$49.48
|
| Rate for Payer: Coventry All Commercial |
$46.82
|
| Rate for Payer: Encore All Commercial |
$48.97
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Humana ChoiceCare |
$45.95
|
| Rate for Payer: Humana Medicare |
$27.13
|
| Rate for Payer: Lucent All Commercial |
$27.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.88
|
| Rate for Payer: Managed Health Services Medicaid |
$74.57
|
| Rate for Payer: MDWise Medicaid |
$74.57
|
| Rate for Payer: PHCS All Commercial |
$39.90
|
| Rate for Payer: PHP All Commercial |
$40.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.75
|
| Rate for Payer: Sagamore Health Network All Products |
$41.07
|
| Rate for Payer: Signature Care EPO |
$44.16
|
| Rate for Payer: Signature Care PPO |
$46.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.22
|
| Rate for Payer: United Healthcare Commercial |
$41.92
|
| Rate for Payer: United Healthcare Medicare |
$17.56
|
|
|
SODIUM CHLORIDE 0.9 % IV PGBK
|
Facility
IP
|
$53.20
|
|
|
Service Code
|
NDC 00338915930
|
| Hospital Charge Code |
117813
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cigna All Commercial |
$45.91
|
| Rate for Payer: CORVEL All Commercial |
$49.48
|
| Rate for Payer: Coventry All Commercial |
$46.82
|
| Rate for Payer: Encore All Commercial |
$48.97
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Humana ChoiceCare |
$45.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.88
|
| Rate for Payer: PHCS All Commercial |
$39.90
|
| Rate for Payer: PHP All Commercial |
$40.35
|
| Rate for Payer: Sagamore Health Network All Products |
$41.07
|
| Rate for Payer: Signature Care EPO |
$44.16
|
| Rate for Payer: Signature Care PPO |
$46.82
|
| Rate for Payer: United Healthcare Commercial |
$41.92
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
IP
|
$17.85
|
|
|
Service Code
|
NDC 00338004941
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna Commercial |
$15.42
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cigna All Commercial |
$15.40
|
| Rate for Payer: CORVEL All Commercial |
$16.60
|
| Rate for Payer: Coventry All Commercial |
$15.71
|
| Rate for Payer: Encore All Commercial |
$16.43
|
| Rate for Payer: Frontpath All Commercial |
$16.42
|
| Rate for Payer: Humana ChoiceCare |
$15.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.06
|
| Rate for Payer: PHCS All Commercial |
$13.39
|
| Rate for Payer: PHP All Commercial |
$13.54
|
| Rate for Payer: Sagamore Health Network All Products |
$13.78
|
| Rate for Payer: Signature Care EPO |
$14.82
|
| Rate for Payer: Signature Care PPO |
$15.71
|
| Rate for Payer: United Healthcare Commercial |
$14.07
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
IP
|
$18.90
|
|
|
Service Code
|
NDC 00338004948
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cigna All Commercial |
$16.31
|
| Rate for Payer: CORVEL All Commercial |
$17.58
|
| Rate for Payer: Coventry All Commercial |
$16.63
|
| Rate for Payer: Encore All Commercial |
$17.40
|
| Rate for Payer: Frontpath All Commercial |
$17.39
|
| Rate for Payer: Humana ChoiceCare |
$16.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.01
|
| Rate for Payer: PHCS All Commercial |
$14.18
|
| Rate for Payer: PHP All Commercial |
$14.33
|
| Rate for Payer: Sagamore Health Network All Products |
$14.59
|
| Rate for Payer: Signature Care EPO |
$15.69
|
| Rate for Payer: Signature Care PPO |
$16.63
|
| Rate for Payer: United Healthcare Commercial |
$14.89
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Centivo All Commercial |
$17.85
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Humana Medicare |
$17.85
|
| Rate for Payer: Lucent All Commercial |
$17.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
OP
|
$18.90
|
|
|
Service Code
|
NDC 00338004948
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Aetna Commercial |
$15.95
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.86
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Centivo All Commercial |
$9.64
|
| Rate for Payer: Cigna All Commercial |
$16.31
|
| Rate for Payer: CORVEL All Commercial |
$17.58
|
| Rate for Payer: Coventry All Commercial |
$16.63
|
| Rate for Payer: Encore All Commercial |
$17.40
|
| Rate for Payer: Frontpath All Commercial |
$17.39
|
| Rate for Payer: Humana ChoiceCare |
$16.32
|
| Rate for Payer: Humana Medicare |
$9.64
|
| Rate for Payer: Lucent All Commercial |
$9.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.01
|
| Rate for Payer: PHCS All Commercial |
$14.18
|
| Rate for Payer: PHP All Commercial |
$14.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.37
|
| Rate for Payer: Sagamore Health Network All Products |
$14.59
|
| Rate for Payer: Signature Care EPO |
$15.69
|
| Rate for Payer: Signature Care PPO |
$16.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.06
|
| Rate for Payer: United Healthcare Commercial |
$14.89
|
| Rate for Payer: United Healthcare Medicare |
$6.24
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
IP
|
$29.75
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna All Commercial |
$25.67
|
| Rate for Payer: CORVEL All Commercial |
$27.67
|
| Rate for Payer: Coventry All Commercial |
$26.18
|
| Rate for Payer: Encore All Commercial |
$27.38
|
| Rate for Payer: Frontpath All Commercial |
$27.37
|
| Rate for Payer: Humana ChoiceCare |
$25.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.78
|
| Rate for Payer: PHCS All Commercial |
$22.31
|
| Rate for Payer: PHP All Commercial |
$22.56
|
| Rate for Payer: Sagamore Health Network All Products |
$22.97
|
| Rate for Payer: Signature Care EPO |
$24.69
|
| Rate for Payer: Signature Care PPO |
$26.18
|
| Rate for Payer: United Healthcare Commercial |
$23.44
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
OP
|
$66.50
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$21.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.14
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Centivo All Commercial |
$33.92
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Humana Medicare |
$33.92
|
| Rate for Payer: Lucent All Commercial |
$33.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.94
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
| Rate for Payer: United Healthcare Medicare |
$21.94
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
OP
|
$29.75
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Aetna Commercial |
$25.11
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Centivo All Commercial |
$15.17
|
| Rate for Payer: Cigna All Commercial |
$25.67
|
| Rate for Payer: CORVEL All Commercial |
$27.67
|
| Rate for Payer: Coventry All Commercial |
$26.18
|
| Rate for Payer: Encore All Commercial |
$27.38
|
| Rate for Payer: Frontpath All Commercial |
$27.37
|
| Rate for Payer: Humana ChoiceCare |
$25.70
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Lucent All Commercial |
$15.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.78
|
| Rate for Payer: PHCS All Commercial |
$22.31
|
| Rate for Payer: PHP All Commercial |
$22.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.60
|
| Rate for Payer: Sagamore Health Network All Products |
$22.97
|
| Rate for Payer: Signature Care EPO |
$24.69
|
| Rate for Payer: Signature Care PPO |
$26.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.29
|
| Rate for Payer: United Healthcare Commercial |
$23.44
|
| Rate for Payer: United Healthcare Medicare |
$9.82
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
OP
|
$17.85
|
|
|
Service Code
|
NDC 00338004941
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna Commercial |
$15.07
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Centivo All Commercial |
$9.10
|
| Rate for Payer: Cigna All Commercial |
$15.40
|
| Rate for Payer: CORVEL All Commercial |
$16.60
|
| Rate for Payer: Coventry All Commercial |
$15.71
|
| Rate for Payer: Encore All Commercial |
$16.43
|
| Rate for Payer: Frontpath All Commercial |
$16.42
|
| Rate for Payer: Humana ChoiceCare |
$15.42
|
| Rate for Payer: Humana Medicare |
$9.10
|
| Rate for Payer: Lucent All Commercial |
$9.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.06
|
| Rate for Payer: PHCS All Commercial |
$13.39
|
| Rate for Payer: PHP All Commercial |
$13.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.96
|
| Rate for Payer: Sagamore Health Network All Products |
$13.78
|
| Rate for Payer: Signature Care EPO |
$14.82
|
| Rate for Payer: Signature Care PPO |
$15.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.17
|
| Rate for Payer: United Healthcare Commercial |
$14.07
|
| Rate for Payer: United Healthcare Medicare |
$5.89
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
IP
|
$66.50
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP (IN ML/KG/HR)
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Centivo All Commercial |
$17.85
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Humana Medicare |
$17.85
|
| Rate for Payer: Lucent All Commercial |
$17.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP (IN ML/KG/HR)
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
600169
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
|
|
SODIUM CHLORIDE 0.9% KCL 20 MEQ/L IV SOLP
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$71.61 |
| Rate for Payer: Aetna Commercial |
$66.53
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cigna All Commercial |
$66.45
|
| Rate for Payer: CORVEL All Commercial |
$71.61
|
| Rate for Payer: Coventry All Commercial |
$67.76
|
| Rate for Payer: Encore All Commercial |
$70.88
|
| Rate for Payer: Frontpath All Commercial |
$70.84
|
| Rate for Payer: Humana ChoiceCare |
$66.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.30
|
| Rate for Payer: PHCS All Commercial |
$57.75
|
| Rate for Payer: PHP All Commercial |
$58.40
|
| Rate for Payer: Sagamore Health Network All Products |
$59.44
|
| Rate for Payer: Signature Care EPO |
$63.91
|
| Rate for Payer: Signature Care PPO |
$67.76
|
| Rate for Payer: United Healthcare Commercial |
$60.68
|
|
|
SODIUM CHLORIDE 0.9% KCL 20 MEQ/L IV SOLP
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$71.61 |
| Rate for Payer: Aetna Commercial |
$64.99
|
| Rate for Payer: Aetna Medicare |
$25.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.95
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Centivo All Commercial |
$39.27
|
| Rate for Payer: Cigna All Commercial |
$66.45
|
| Rate for Payer: CORVEL All Commercial |
$71.61
|
| Rate for Payer: Coventry All Commercial |
$67.76
|
| Rate for Payer: Encore All Commercial |
$70.88
|
| Rate for Payer: Frontpath All Commercial |
$70.84
|
| Rate for Payer: Humana ChoiceCare |
$66.50
|
| Rate for Payer: Humana Medicare |
$39.27
|
| Rate for Payer: Lucent All Commercial |
$39.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.30
|
| Rate for Payer: PHCS All Commercial |
$57.75
|
| Rate for Payer: PHP All Commercial |
$58.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.03
|
| Rate for Payer: Sagamore Health Network All Products |
$59.44
|
| Rate for Payer: Signature Care EPO |
$63.91
|
| Rate for Payer: Signature Care PPO |
$67.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.45
|
| Rate for Payer: United Healthcare Commercial |
$60.68
|
| Rate for Payer: United Healthcare Medicare |
$25.41
|
|
|
SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE
|
Facility
OP
|
$14.49
|
|
|
Service Code
|
NDC 00409488812
|
| Hospital Charge Code |
800315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.26
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Centivo All Commercial |
$7.39
|
| Rate for Payer: Cigna All Commercial |
$12.50
|
| Rate for Payer: CORVEL All Commercial |
$13.48
|
| Rate for Payer: Coventry All Commercial |
$12.75
|
| Rate for Payer: Encore All Commercial |
$13.34
|
| Rate for Payer: Frontpath All Commercial |
$13.33
|
| Rate for Payer: Humana ChoiceCare |
$12.52
|
| Rate for Payer: Humana Medicare |
$7.39
|
| Rate for Payer: Lucent All Commercial |
$7.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.04
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$10.87
|
| Rate for Payer: PHP All Commercial |
$10.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.65
|
| Rate for Payer: Sagamore Health Network All Products |
$11.19
|
| Rate for Payer: Signature Care EPO |
$12.03
|
| Rate for Payer: Signature Care PPO |
$12.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$11.42
|
| Rate for Payer: United Healthcare Medicare |
$4.78
|
|
|
SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE
|
Facility
IP
|
$14.49
|
|
|
Service Code
|
NDC 00409488812
|
| Hospital Charge Code |
800315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna Commercial |
$12.52
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cigna All Commercial |
$12.50
|
| Rate for Payer: CORVEL All Commercial |
$13.48
|
| Rate for Payer: Coventry All Commercial |
$12.75
|
| Rate for Payer: Encore All Commercial |
$13.34
|
| Rate for Payer: Frontpath All Commercial |
$13.33
|
| Rate for Payer: Humana ChoiceCare |
$12.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.04
|
| Rate for Payer: PHCS All Commercial |
$10.87
|
| Rate for Payer: PHP All Commercial |
$10.99
|
| Rate for Payer: Sagamore Health Network All Products |
$11.19
|
| Rate for Payer: Signature Care EPO |
$12.03
|
| Rate for Payer: Signature Care PPO |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$11.42
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.10
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.08
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Centivo All Commercial |
$12.75
|
| Rate for Payer: Cigna All Commercial |
$21.58
|
| Rate for Payer: CORVEL All Commercial |
$23.25
|
| Rate for Payer: Coventry All Commercial |
$22.00
|
| Rate for Payer: Encore All Commercial |
$23.01
|
| Rate for Payer: Frontpath All Commercial |
$23.00
|
| Rate for Payer: Humana ChoiceCare |
$21.59
|
| Rate for Payer: Humana Medicare |
$12.75
|
| Rate for Payer: Lucent All Commercial |
$12.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$18.75
|
| Rate for Payer: PHP All Commercial |
$18.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.75
|
| Rate for Payer: Sagamore Health Network All Products |
$19.30
|
| Rate for Payer: Signature Care EPO |
$20.75
|
| Rate for Payer: Signature Care PPO |
$22.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.25
|
| Rate for Payer: United Healthcare Commercial |
$19.70
|
| Rate for Payer: United Healthcare Medicare |
$8.25
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
7321
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna All Commercial |
$21.58
|
| Rate for Payer: CORVEL All Commercial |
$23.25
|
| Rate for Payer: Coventry All Commercial |
$22.00
|
| Rate for Payer: Encore All Commercial |
$23.01
|
| Rate for Payer: Frontpath All Commercial |
$23.00
|
| Rate for Payer: Humana ChoiceCare |
$21.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$18.75
|
| Rate for Payer: PHP All Commercial |
$18.96
|
| Rate for Payer: Sagamore Health Network All Products |
$19.30
|
| Rate for Payer: Signature Care EPO |
$20.75
|
| Rate for Payer: Signature Care PPO |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$19.70
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - CAMERON
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
1401000007321
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna All Commercial |
$21.58
|
| Rate for Payer: CORVEL All Commercial |
$23.25
|
| Rate for Payer: Coventry All Commercial |
$22.00
|
| Rate for Payer: Encore All Commercial |
$23.01
|
| Rate for Payer: Frontpath All Commercial |
$23.00
|
| Rate for Payer: Humana ChoiceCare |
$21.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$18.75
|
| Rate for Payer: PHP All Commercial |
$18.96
|
| Rate for Payer: Sagamore Health Network All Products |
$19.30
|
| Rate for Payer: Signature Care EPO |
$20.75
|
| Rate for Payer: Signature Care PPO |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$19.70
|
|
|
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - CAMERON
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
1401000007321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.10
|
| Rate for Payer: Aetna Medicare |
$8.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.08
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Centivo All Commercial |
$12.75
|
| Rate for Payer: Cigna All Commercial |
$21.58
|
| Rate for Payer: CORVEL All Commercial |
$23.25
|
| Rate for Payer: Coventry All Commercial |
$22.00
|
| Rate for Payer: Encore All Commercial |
$23.01
|
| Rate for Payer: Frontpath All Commercial |
$23.00
|
| Rate for Payer: Humana ChoiceCare |
$21.59
|
| Rate for Payer: Humana Medicare |
$12.75
|
| Rate for Payer: Lucent All Commercial |
$12.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$18.75
|
| Rate for Payer: PHP All Commercial |
$18.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.75
|
| Rate for Payer: Sagamore Health Network All Products |
$19.30
|
| Rate for Payer: Signature Care EPO |
$20.75
|
| Rate for Payer: Signature Care PPO |
$22.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.25
|
| Rate for Payer: United Healthcare Commercial |
$19.70
|
| Rate for Payer: United Healthcare Medicare |
$8.25
|
|
|
SODIUM CHLORIDE 3 % INHL NEBU
|
Facility
OP
|
$3.92
|
|
|
Service Code
|
NDC 76204002260
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.42
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Centivo All Commercial |
$2.00
|
| Rate for Payer: Cigna All Commercial |
$3.38
|
| Rate for Payer: CORVEL All Commercial |
$3.65
|
| Rate for Payer: Coventry All Commercial |
$3.45
|
| Rate for Payer: Encore All Commercial |
$3.61
|
| Rate for Payer: Frontpath All Commercial |
$3.61
|
| Rate for Payer: Humana ChoiceCare |
$3.39
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Lucent All Commercial |
$2.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.53
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$2.94
|
| Rate for Payer: PHP All Commercial |
$2.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3.03
|
| Rate for Payer: Signature Care EPO |
$3.25
|
| Rate for Payer: Signature Care PPO |
$3.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
|
|
SODIUM CHLORIDE 3 % INHL NEBU
|
Facility
IP
|
$3.92
|
|
|
Service Code
|
NDC 76204002260
|
| Hospital Charge Code |
7327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna All Commercial |
$3.38
|
| Rate for Payer: CORVEL All Commercial |
$3.65
|
| Rate for Payer: Coventry All Commercial |
$3.45
|
| Rate for Payer: Encore All Commercial |
$3.61
|
| Rate for Payer: Frontpath All Commercial |
$3.61
|
| Rate for Payer: Humana ChoiceCare |
$3.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.53
|
| Rate for Payer: PHCS All Commercial |
$2.94
|
| Rate for Payer: PHP All Commercial |
$2.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3.03
|
| Rate for Payer: Signature Care EPO |
$3.25
|
| Rate for Payer: Signature Care PPO |
$3.45
|
| Rate for Payer: United Healthcare Commercial |
$3.09
|
|
|
SODIUM CHLORIDE 4 MEQ/ML IV SOLN
|
Facility
OP
|
$49.77
|
|
|
Service Code
|
NDC 63323009330
|
| Hospital Charge Code |
7322
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$42.01
|
| Rate for Payer: Aetna Medicare |
$16.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$74.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.07
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Centivo All Commercial |
$25.38
|
| Rate for Payer: Cigna All Commercial |
$42.95
|
| Rate for Payer: CORVEL All Commercial |
$46.29
|
| Rate for Payer: Coventry All Commercial |
$43.80
|
| Rate for Payer: Encore All Commercial |
$45.81
|
| Rate for Payer: Frontpath All Commercial |
$45.79
|
| Rate for Payer: Humana ChoiceCare |
$42.99
|
| Rate for Payer: Humana Medicare |
$25.38
|
| Rate for Payer: Lucent All Commercial |
$25.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.79
|
| Rate for Payer: Managed Health Services Medicaid |
$74.57
|
| Rate for Payer: MDWise Medicaid |
$74.57
|
| Rate for Payer: PHCS All Commercial |
$37.33
|
| Rate for Payer: PHP All Commercial |
$37.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.41
|
| Rate for Payer: Sagamore Health Network All Products |
$38.42
|
| Rate for Payer: Signature Care EPO |
$41.31
|
| Rate for Payer: Signature Care PPO |
$43.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.30
|
| Rate for Payer: United Healthcare Commercial |
$39.22
|
| Rate for Payer: United Healthcare Medicare |
$16.42
|
|
