|
SODIUM CHLORIDE 0.9 % IR SOLN
|
Facility
|
OP
|
$43.75
|
|
|
Service Code
|
NDC 00338004802
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna Commercial |
$36.92
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.40
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Centivo All Commercial |
$23.80
|
| Rate for Payer: Cigna All Commercial |
$37.76
|
| Rate for Payer: CORVEL All Commercial |
$40.69
|
| Rate for Payer: Coventry All Commercial |
$38.50
|
| Rate for Payer: Encore All Commercial |
$40.27
|
| Rate for Payer: Frontpath All Commercial |
$40.25
|
| Rate for Payer: Humana ChoiceCare |
$37.79
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Lucent All Commercial |
$23.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.38
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$32.81
|
| Rate for Payer: PHP All Commercial |
$33.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.06
|
| Rate for Payer: Sagamore Health Network All Products |
$33.77
|
| Rate for Payer: Signature Care EPO |
$36.31
|
| Rate for Payer: Signature Care PPO |
$38.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.19
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
|
|
SODIUM CHLORIDE 0.9 % IR SOLN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 00338004804
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.45
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Centivo All Commercial |
$22.85
|
| Rate for Payer: Cigna All Commercial |
$36.25
|
| Rate for Payer: CORVEL All Commercial |
$39.06
|
| Rate for Payer: Coventry All Commercial |
$36.96
|
| Rate for Payer: Encore All Commercial |
$38.66
|
| Rate for Payer: Frontpath All Commercial |
$38.64
|
| Rate for Payer: Humana ChoiceCare |
$36.28
|
| Rate for Payer: Humana Medicare |
$13.44
|
| Rate for Payer: Lucent All Commercial |
$22.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.80
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$31.50
|
| Rate for Payer: PHP All Commercial |
$31.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.38
|
| Rate for Payer: Sagamore Health Network All Products |
$32.42
|
| Rate for Payer: Signature Care EPO |
$34.86
|
| Rate for Payer: Signature Care PPO |
$36.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$33.10
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
|
|
SODIUM CHLORIDE 0.9 % IR SOLN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 00990797208
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.61
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
SODIUM CHLORIDE 0.9 % IR SOLN
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 00338004804
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$36.29
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cigna All Commercial |
$36.25
|
| Rate for Payer: CORVEL All Commercial |
$39.06
|
| Rate for Payer: Coventry All Commercial |
$36.96
|
| Rate for Payer: Encore All Commercial |
$38.66
|
| Rate for Payer: Frontpath All Commercial |
$38.64
|
| Rate for Payer: Humana ChoiceCare |
$36.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.80
|
| Rate for Payer: PHCS All Commercial |
$31.50
|
| Rate for Payer: PHP All Commercial |
$31.85
|
| Rate for Payer: Sagamore Health Network All Products |
$32.42
|
| Rate for Payer: Signature Care EPO |
$34.86
|
| Rate for Payer: Signature Care PPO |
$36.96
|
| Rate for Payer: United Healthcare Commercial |
$33.10
|
|
|
SODIUM CHLORIDE 0.9 % IR SOLN
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 00338004802
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cigna All Commercial |
$37.76
|
| Rate for Payer: CORVEL All Commercial |
$40.69
|
| Rate for Payer: Coventry All Commercial |
$38.50
|
| Rate for Payer: Encore All Commercial |
$40.27
|
| Rate for Payer: Frontpath All Commercial |
$40.25
|
| Rate for Payer: Humana ChoiceCare |
$37.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.38
|
| Rate for Payer: PHCS All Commercial |
$32.81
|
| Rate for Payer: PHP All Commercial |
$33.18
|
| Rate for Payer: Sagamore Health Network All Products |
$33.77
|
| Rate for Payer: Signature Care EPO |
$36.31
|
| Rate for Payer: Signature Care PPO |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
|
|
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 PGBK
|
Facility
|
OP
|
$53.20
|
|
|
Service Code
|
NDC 00338915930
|
| Hospital Charge Code |
117813
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Aetna Commercial |
$44.90
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$30.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.73
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Centivo All Commercial |
$28.94
|
| 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 |
$17.02
|
| Rate for Payer: Lucent All Commercial |
$28.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.88
|
| Rate for Payer: Managed Health Services Medicaid |
$19.12
|
| Rate for Payer: MDWise Medicaid |
$19.12
|
| 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 |
$17.02
|
|
|
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 |
$26.77
|
| 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
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cigna All Commercial |
$24.16
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: CORVEL All Commercial |
$26.04
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Coventry All Commercial |
$24.64
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Encore All Commercial |
$25.77
|
| Rate for Payer: Frontpath All Commercial |
$25.76
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHCS All Commercial |
$21.00
|
| Rate for Payer: PHP All Commercial |
$21.24
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Sagamore Health Network All Products |
$21.62
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care EPO |
$23.24
|
| Rate for Payer: Signature Care PPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Commercial |
$22.06
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cigna All Commercial |
$18.12
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$19.53
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Coventry All Commercial |
$18.48
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Encore All Commercial |
$19.33
|
| Rate for Payer: Frontpath All Commercial |
$19.32
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$18.14
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHCS All Commercial |
$15.75
|
| Rate for Payer: PHP All Commercial |
$15.93
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Sagamore Health Network All Products |
$16.21
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care EPO |
$17.43
|
| Rate for Payer: Signature Care PPO |
$18.48
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 00338004948
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cigna All Commercial |
$18.12
|
| Rate for Payer: CORVEL All Commercial |
$19.53
|
| Rate for Payer: Coventry All Commercial |
$18.48
|
| Rate for Payer: Encore All Commercial |
$19.33
|
| Rate for Payer: Frontpath All Commercial |
$19.32
|
| Rate for Payer: Humana ChoiceCare |
$18.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$15.75
|
| Rate for Payer: PHP All Commercial |
$15.93
|
| Rate for Payer: Sagamore Health Network All Products |
$16.21
|
| Rate for Payer: Signature Care EPO |
$17.43
|
| Rate for Payer: Signature Care PPO |
$18.48
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
|
|
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 |
$10.85 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Centivo All Commercial |
$11.42
|
| Rate for Payer: Centivo All Commercial |
$19.04
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: Cigna All Commercial |
$18.12
|
| Rate for Payer: CORVEL All Commercial |
$19.53
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$18.48
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Encore All Commercial |
$19.33
|
| Rate for Payer: Frontpath All Commercial |
$19.32
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Humana ChoiceCare |
$18.14
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$6.72
|
| Rate for Payer: Lucent All Commercial |
$11.42
|
| Rate for Payer: Lucent All Commercial |
$19.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$15.75
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$15.93
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.19
|
| Rate for Payer: Sagamore Health Network All Products |
$16.21
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care EPO |
$17.43
|
| Rate for Payer: Signature Care PPO |
$18.48
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$6.72
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
|
|
SODIUM CHLORIDE 0.9 % IV SOLP
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Commercial |
$23.63
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$23.87
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: Centivo All Commercial |
$15.23
|
| Rate for Payer: Centivo All Commercial |
$20.94
|
| Rate for Payer: Cigna All Commercial |
$33.23
|
| Rate for Payer: Cigna All Commercial |
$24.16
|
| Rate for Payer: CORVEL All Commercial |
$26.04
|
| Rate for Payer: CORVEL All Commercial |
$35.80
|
| Rate for Payer: Coventry All Commercial |
$24.64
|
| Rate for Payer: Coventry All Commercial |
$33.88
|
| Rate for Payer: Encore All Commercial |
$35.44
|
| Rate for Payer: Encore All Commercial |
$25.77
|
| Rate for Payer: Frontpath All Commercial |
$25.76
|
| Rate for Payer: Frontpath All Commercial |
$35.42
|
| Rate for Payer: Humana ChoiceCare |
$33.25
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Humana Medicare |
$8.96
|
| Rate for Payer: Lucent All Commercial |
$15.23
|
| Rate for Payer: Lucent All Commercial |
$20.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.20
|
| Rate for Payer: PHCS All Commercial |
$21.00
|
| Rate for Payer: PHCS All Commercial |
$28.88
|
| Rate for Payer: PHP All Commercial |
$21.24
|
| Rate for Payer: PHP All Commercial |
$29.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.92
|
| Rate for Payer: Sagamore Health Network All Products |
$21.62
|
| Rate for Payer: Sagamore Health Network All Products |
$29.72
|
| Rate for Payer: Signature Care EPO |
$31.95
|
| Rate for Payer: Signature Care EPO |
$23.24
|
| Rate for Payer: Signature Care PPO |
$24.64
|
| Rate for Payer: Signature Care PPO |
$33.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$22.06
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare |
$8.96
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
|
|
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 |
$16.07
|
| 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
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 00338004948
|
| Hospital Charge Code |
27838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.39
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Centivo All Commercial |
$11.42
|
| Rate for Payer: Cigna All Commercial |
$18.12
|
| Rate for Payer: CORVEL All Commercial |
$19.53
|
| Rate for Payer: Coventry All Commercial |
$18.48
|
| Rate for Payer: Encore All Commercial |
$19.33
|
| Rate for Payer: Frontpath All Commercial |
$19.32
|
| Rate for Payer: Humana ChoiceCare |
$18.14
|
| Rate for Payer: Humana Medicare |
$6.72
|
| Rate for Payer: Lucent All Commercial |
$11.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$15.75
|
| Rate for Payer: PHP All Commercial |
$15.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.19
|
| Rate for Payer: Sagamore Health Network All Products |
$16.21
|
| Rate for Payer: Signature Care EPO |
$17.43
|
| Rate for Payer: Signature Care PPO |
$18.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
| Rate for Payer: United Healthcare Medicare |
$6.72
|
|
|
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 |
$5.53 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna Commercial |
$15.07
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.28
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Centivo All Commercial |
$9.71
|
| 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 |
$5.71
|
| Rate for Payer: Lucent All Commercial |
$9.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.07
|
| 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 |
$5.71
|
|
|
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 |
$9.22 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Aetna Commercial |
$25.11
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.47
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Centivo All Commercial |
$16.18
|
| 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 |
$9.52
|
| Rate for Payer: Lucent All Commercial |
$16.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.77
|
| 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 |
$9.52
|
|
|
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 |
$10.85 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Centivo All Commercial |
$19.04
|
| 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 |
$11.20
|
| Rate for Payer: Lucent All Commercial |
$19.04
|
| 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 |
$11.20
|
|
|
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
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$71.61 |
| Rate for Payer: Aetna Commercial |
$64.99
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.10
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Centivo All Commercial |
$41.89
|
| 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 |
$24.64
|
| Rate for Payer: Lucent All Commercial |
$41.89
|
| 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 |
$24.64
|
|
|
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 % VIAL - NO CHARGE
|
Facility
|
OP
|
$14.49
|
|
|
Service Code
|
NDC 00409488812
|
| Hospital Charge Code |
800315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.10
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Centivo All Commercial |
$7.88
|
| 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 |
$4.64
|
| Rate for Payer: Lucent All Commercial |
$7.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.04
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| 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 |
$4.64
|
|
|
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 1000 MG MISC TBSO
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 00904723961
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$1.18
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.49
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Centivo All Commercial |
$0.76
|
| Rate for Payer: Cigna All Commercial |
$1.20
|
| Rate for Payer: CORVEL All Commercial |
$1.30
|
| Rate for Payer: Coventry All Commercial |
$1.23
|
| Rate for Payer: Encore All Commercial |
$1.28
|
| Rate for Payer: Frontpath All Commercial |
$1.28
|
| Rate for Payer: Humana ChoiceCare |
$1.20
|
| Rate for Payer: Humana Medicare |
$0.45
|
| Rate for Payer: Lucent All Commercial |
$0.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.25
|
| Rate for Payer: PHCS All Commercial |
$1.04
|
| Rate for Payer: PHP All Commercial |
$1.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1.08
|
| Rate for Payer: Signature Care EPO |
$1.16
|
| Rate for Payer: Signature Care PPO |
$1.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
|
|
SODIUM CHLORIDE 1000 MG MISC TBSO
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 00904723961
|
| Hospital Charge Code |
94158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna All Commercial |
$1.20
|
| Rate for Payer: CORVEL All Commercial |
$1.30
|
| Rate for Payer: Coventry All Commercial |
$1.23
|
| Rate for Payer: Encore All Commercial |
$1.28
|
| Rate for Payer: Frontpath All Commercial |
$1.28
|
| Rate for Payer: Humana ChoiceCare |
$1.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.25
|
| Rate for Payer: PHCS All Commercial |
$1.04
|
| Rate for Payer: PHP All Commercial |
$1.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1.08
|
| Rate for Payer: Signature Care EPO |
$1.16
|
| Rate for Payer: Signature Care PPO |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
|
