|
VITAMIN B COMPLEX AND C NO.10-FOLIC ACID 900 MCG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$395.44
|
|
|
Service Code
|
NDC 54859051608
|
| Hospital Charge Code |
32716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.41 |
| Max. Negotiated Rate |
$355.90 |
| Rate for Payer: Aetna Commercial |
$336.12
|
| Rate for Payer: Aetna Medicare |
$197.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.04
|
| Rate for Payer: BCBS Complete |
$158.18
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cofinity Advantage |
$276.81
|
| Rate for Payer: Cofinity Commercial |
$340.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.35
|
| Rate for Payer: Healthscope Commercial |
$355.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.58
|
| Rate for Payer: PHP Commercial |
$336.12
|
| Rate for Payer: Priority Health SBD |
$249.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$206.02
|
| Rate for Payer: UHC Exchange |
$155.41
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.21
|
| Rate for Payer: UHC Core |
$53.87
|
| Rate for Payer: UHC Exchange |
$40.64
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
NDC 77333095125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Advantage |
$1.43
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.29
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
NDC 77333095125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Advantage |
$1.43
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.33
|
| Rate for Payer: UHC Core |
$1.06
|
| Rate for Payer: UHC Exchange |
$0.80
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
OP
|
$203.50
|
|
|
Service Code
|
NDC 77333095110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna Medicare |
$101.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cofinity Advantage |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.62
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: Priority Health SBD |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.28
|
| Rate for Payer: UHC Core |
$106.02
|
| Rate for Payer: UHC Exchange |
$79.98
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$203.50
|
|
|
Service Code
|
NDC 77333095110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.21 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: Aetna Commercial |
$172.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cofinity Advantage |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.62
|
| Rate for Payer: PHP Commercial |
$172.97
|
| Rate for Payer: Priority Health SBD |
$128.21
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna Medicare |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Advantage |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.33
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health SBD |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.82
|
| Rate for Payer: UHC Core |
$7.87
|
| Rate for Payer: UHC Exchange |
$5.94
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Advantage |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$13.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.33
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health SBD |
$9.52
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.86
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Exchange |
$17.45
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: BCBS Complete |
$16.28
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Exchange |
$16.00
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.86
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Exchange |
$17.45
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: BCBS Complete |
$16.28
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Exchange |
$16.00
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: BCBS Complete |
$16.28
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Exchange |
$16.00
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.86
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Exchange |
$17.45
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
NDC 43900036280
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.45
|
| Rate for Payer: BCBS Complete |
$16.28
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Advantage |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.52
|
| Rate for Payer: PHP Commercial |
$34.59
|
| Rate for Payer: Priority Health SBD |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Exchange |
$16.00
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$44.40
|
|
|
Service Code
|
NDC 00212362814
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$37.74
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.86
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: Cash Price |
$35.52
|
| Rate for Payer: Cofinity Advantage |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.30
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health SBD |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.86
|
| Rate for Payer: UHC Core |
$23.13
|
| Rate for Payer: UHC Exchange |
$17.45
|
|
