|
potassium chloride 10 mEq Cap [HMC]
|
Facility
|
OP
|
$9.24
|
|
|
Service Code
|
NDC 70010014801
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.70
|
| Rate for Payer: WPPA Medicare Advantage |
$5.54
|
|
|
potassium chloride 10 mEq ER Cap [HMC]
|
Facility
|
OP
|
$8.54
|
|
|
Service Code
|
NDC 60687065321
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Humana Medicare Advantage |
$3.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.42
|
| Rate for Payer: WPPA Medicare Advantage |
$5.12
|
|
|
potassium chloride 10 mEq ER Cap [HMC]
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 60687065321
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.11
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
IP
|
$8.07
|
|
|
Service Code
|
NDC 00904693061
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.67
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
OP
|
$8.07
|
|
|
Service Code
|
NDC 00904693061
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.67 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: Humana Medicare Advantage |
$3.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.23
|
| Rate for Payer: WPPA Medicare Advantage |
$4.84
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 50268067113
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.15
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 50268067113
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Humana Medicare Advantage |
$7.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.80
|
| Rate for Payer: WPPA Medicare Advantage |
$10.20
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
OP
|
$8.06
|
|
|
Service Code
|
NDC 60687065301
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Humana Medicare Advantage |
$3.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.22
|
| Rate for Payer: WPPA Medicare Advantage |
$4.84
|
|
|
potassium chloride 10 mEq ER Cap UD [HMC]
|
Facility
|
IP
|
$8.06
|
|
|
Service Code
|
NDC 60687065301
|
| Hospital Charge Code |
3808250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.66
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$6.85
|
|
|
Service Code
|
NDC 00245531701
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Humana Medicare Advantage |
$2.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.74
|
| Rate for Payer: WPPA Medicare Advantage |
$4.11
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.78
|
| Rate for Payer: WPPA Medicare Advantage |
$4.17
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$5.77
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.48
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$5.77
|
|
|
Service Code
|
NDC 60687081009
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Humana Medicare Advantage |
$2.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.31
|
| Rate for Payer: WPPA Medicare Advantage |
$3.46
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$6.85
|
|
|
Service Code
|
NDC 00245531701
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$6.17
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.86
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 60687046601
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$2.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.74
|
| Rate for Payer: WPPA Medicare Advantage |
$4.10
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$5.98
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.68
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.60
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$6.33
|
|
|
Service Code
|
NDC 00904729261
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$2.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.53
|
| Rate for Payer: WPPA Medicare Advantage |
$3.80
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$5.98
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna Commercial |
$5.38
|
| Rate for Payer: Humana Medicare Advantage |
$2.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.39
|
| Rate for Payer: WPPA Medicare Advantage |
$3.59
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
OP
|
$6.17
|
|
|
Service Code
|
NDC 00574027511
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: Humana Medicare Advantage |
$2.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.47
|
| Rate for Payer: WPPA Medicare Advantage |
$3.70
|
|
|
potassium chloride 10 mEq ER Tab [HMC]
|
Facility
|
IP
|
$6.33
|
|
|
Service Code
|
NDC 00904729261
|
| Hospital Charge Code |
3808249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.01
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 20 mEq/15 mL Oral Liq [HMC]
|
Facility
|
IP
|
$32.63
|
|
|
Service Code
|
NDC 71656002101
|
| Hospital Charge Code |
3808561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
potassium chloride 20 mEq/15 mL Oral Liq [HMC]
|
Facility
|
OP
|
$55.10
|
|
|
Service Code
|
NDC 60687034171
|
| Hospital Charge Code |
3808561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$49.59
|
| Rate for Payer: Humana Medicare Advantage |
$23.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.04
|
| Rate for Payer: WPPA Medicare Advantage |
$33.06
|
|
