|
SODIUM BICARBONATE 4.2% INJ 5 ML
|
Facility
OP
|
$4.02
|
|
| Hospital Charge Code |
41654268
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.73
|
| Rate for Payer: Group Health Inc Commercial |
$2.01
|
| Rate for Payer: Group Health Inc Medicare |
$1.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.61
|
|
|
SODIUM BICARBONATE 4.2% SYRINGE 10 ML
|
Facility
OP
|
$9.28
|
|
| Hospital Charge Code |
41653821
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.64
|
| Rate for Payer: Aetna Government |
$4.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.31
|
| Rate for Payer: Group Health Inc Commercial |
$4.64
|
| Rate for Payer: Group Health Inc Medicare |
$3.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.03
|
|
|
SODIUM BICARBONATE 4.2% SYRINGE 10 ML
|
Facility
OP
|
$9.28
|
|
| Hospital Charge Code |
41643821
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.64
|
| Rate for Payer: Aetna Government |
$4.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.31
|
| Rate for Payer: Group Health Inc Commercial |
$4.64
|
| Rate for Payer: Group Health Inc Medicare |
$3.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.03
|
|
|
SODIUM BICARBONATE 650 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650894
|
|
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: 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
|
|
|
SODIUM BICARBONATE 650 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640894
|
|
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: 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
|
|
|
SODIUM BICARBONATE 7.5% - 44.6 MEQ/50 ML
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
41645396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
|
SODIUM BICARBONATE 7.5% - 44.6 MEQ/50 ML
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41655397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
SODIUM BICARBONATE 7.5% - 44.6 MEQ/50 ML
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41645397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
SODIUM BICARBONATE 7.5% - 44.6 MEQ/50 ML
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
41655396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
|
SODIUM BICARBONATE 8.4% 50ML SYR
|
Facility
OP
|
$1.49
|
|
| Hospital Charge Code |
41655395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.97
|
|
|
SODIUM BICARBONATE 8.4% 50ML SYR
|
Facility
OP
|
$1.49
|
|
| Hospital Charge Code |
41645395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.97
|
|
|
SODIUM BICARBONATE 8.4% VIAL
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41657071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
SODIUM BICARBONATE 8.4% VIAL
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41647071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
SODIUM CHL,IRRIG,0.9, USP
|
Facility
OP
|
$12.82
|
|
| Hospital Charge Code |
64902540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.41
|
| Rate for Payer: Aetna Government |
$6.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.72
|
| Rate for Payer: Group Health Inc Commercial |
$6.41
|
| Rate for Payer: Group Health Inc Medicare |
$4.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.41
|
|
|
SODIUM CHLORIDE 0.225% INFUSION NEONATAL
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
41651454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
SODIUM CHLORIDE 0.225% INFUSION NEONATAL
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
41641454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
SODIUM CHLORIDE 0.33% INFUSION 50 ML NEO
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41645601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
SODIUM CHLORIDE 0.33% INFUSION 50 ML NEO
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41655601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 1000 ML
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41642214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 1000 ML
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41652214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 500ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41641803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 500ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41651803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 50 ML NEO
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41645600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
SODIUM CHLORIDE 0.45% INFUSION 50 ML NEO
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41655600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
SODIUM CHLORIDE 0.65% NASAL PEDS SOLUTIO
|
Facility
OP
|
$4.84
|
|
| Hospital Charge Code |
41642040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.42
|
| Rate for Payer: Aetna Government |
$2.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.29
|
| Rate for Payer: Group Health Inc Commercial |
$2.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.15
|
|
