|
POTASSIUM IODIDE 1 GM/ML PO SOLN [6445]
|
Facility
|
OP
|
$17.33
|
|
|
Service Code
|
NDC 71740011230
|
| Hospital Charge Code |
71740011230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.66
|
| Rate for Payer: Aetna Government |
$8.66
|
| Rate for Payer: Brighton Health Commercial |
$12.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.66
|
| Rate for Payer: Group Health Inc Medicare |
$6.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.26
|
|
|
POTASSIUM IODIDE-IODINE (LUGOL'S) SOLN
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
41641517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Government |
$21.50
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Group Health Inc Commercial |
$21.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.95
|
|
|
POTASSIUM IODIDE-IODINE (LUGOL'S) SOLN
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
41651517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Government |
$21.50
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Group Health Inc Commercial |
$21.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.95
|
|
|
POTASSIUM PHOSPHATE INJ
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650429
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
POTASSIUM PHOSPHATE INJ
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640429
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN [127663]
|
Facility
|
OP
|
$5.76
|
|
|
Service Code
|
NDC 65219005229
|
| Hospital Charge Code |
65219005229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.88
|
| Rate for Payer: Aetna Government |
$2.88
|
| Rate for Payer: Brighton Health Commercial |
$3.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.31
|
| Rate for Payer: EmblemHealth Commercial |
$2.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.88
|
| Rate for Payer: Group Health Inc Medicare |
$2.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.74
|
|
|
POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN [127663]
|
Facility
|
IP
|
$5.76
|
|
|
Service Code
|
NDC 65219005229
|
| Hospital Charge Code |
65219005229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.88
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
00517210225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.92
|
| Rate for Payer: Aetna Government |
$1.92
|
| Rate for Payer: Brighton Health Commercial |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.21
|
| Rate for Payer: EmblemHealth Commercial |
$1.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.92
|
| Rate for Payer: Group Health Inc Medicare |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.49
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 00409729511
|
| Hospital Charge Code |
00409729511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Brighton Health Commercial |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
00517210201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 00409729511
|
| Hospital Charge Code |
00409729511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
00409729501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 00517210201
|
| Hospital Charge Code |
00517210201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.92
|
| Rate for Payer: Aetna Government |
$1.92
|
| Rate for Payer: Brighton Health Commercial |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.21
|
| Rate for Payer: EmblemHealth Commercial |
$1.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.92
|
| Rate for Payer: Group Health Inc Medicare |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.49
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 00517210225
|
| Hospital Charge Code |
00517210225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
|
|
POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [172079]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
00409729501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Brighton Health Commercial |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
POTASSIUM PHOSPHATES-NACL 15 MMOL/250ML IV SOLN [139083]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 70004084140
|
| Hospital Charge Code |
70004084140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
POTASSIUM PHOSPHATES-NACL 15 MMOL/250ML IV SOLN [139083]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 70004084140
|
| Hospital Charge Code |
70004084140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
POTASSIUM PHOSPHATE + SODIUM PHOSPHATE 2
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
POTASSIUM PHOSPHATE + SODIUM PHOSPHATE 2
|
Facility
|
OP
|
$0.48
|
|
| Hospital Charge Code |
41641755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
POTASSIUM PHOSPHATE + SODIUM PHOSPHATE 2
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41644069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
POTASSIUM PHOSPHATE + SODIUM PHOSPHATE 2
|
Facility
|
OP
|
$0.48
|
|
| Hospital Charge Code |
41651755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
POTASSIUM RANDOM URINE
|
Facility
|
OP
|
$11.83
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
40602615
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.73
|
| Rate for Payer: Aetna Government |
$4.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.31
|
| Rate for Payer: Brighton Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$4.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.21
|
| Rate for Payer: Group Health Inc Commercial |
$4.73
|
| Rate for Payer: Group Health Inc Medicare |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.73
|
| Rate for Payer: Healthfirst QHP |
$4.73
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: Wellcare Medicare |
$4.26
|
|
|
POTASSIUM RANDOM URINE
|
Facility
|
IP
|
$11.83
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
40602615
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.73
|
|
|
POT CL IN D5W LACT RINGERS 20 MEQ/L IV SOLN [11062]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 00338081104
|
| Hospital Charge Code |
00338081104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
POT CL IN D5W LACT RINGERS 20 MEQ/L IV SOLN [11062]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 00990711109
|
| Hospital Charge Code |
00990711109
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
