Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION

Facility

$200.29

Service Code	HCPCS J9370
Hospital Charge Code	118463
Hospital Revenue Code	636
Min. Negotiated Rate	$126.18
Max. Negotiated Rate	$180.26
Rate for Payer: Aetna Commercial	$170.25
Rate for Payer: Aetna New Business (MI Preferred)	$130.19
Rate for Payer: Cash Price	$160.23
Rate for Payer: Cofinity Commercial	$140.20
Rate for Payer: Cofinity Commercial	$172.25
Rate for Payer: Cofinity Medicare Advantage	$140.20
Rate for Payer: Encore Health Key Benefits Commercial	$160.23
Rate for Payer: Healthscope Commercial	$180.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.25
Rate for Payer: PHP Commercial	$170.25
Rate for Payer: Priority Health Cigna Priority Health	$130.19
Rate for Payer: Priority Health SBD	$126.18

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$158.26

Service Code	HCPCS J9390
Hospital Charge Code	14203
Hospital Revenue Code	636
Min. Negotiated Rate	$99.70
Max. Negotiated Rate	$142.43
Rate for Payer: Aetna Commercial	$134.52
Rate for Payer: Aetna New Business (MI Preferred)	$102.87
Rate for Payer: Cash Price	$126.61
Rate for Payer: Cofinity Commercial	$110.78
Rate for Payer: Cofinity Commercial	$136.10
Rate for Payer: Cofinity Medicare Advantage	$110.78
Rate for Payer: Encore Health Key Benefits Commercial	$126.61
Rate for Payer: Healthscope Commercial	$142.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.52
Rate for Payer: PHP Commercial	$134.52
Rate for Payer: Priority Health Cigna Priority Health	$102.87
Rate for Payer: Priority Health SBD	$99.70

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$158.26

Service Code	HCPCS J9390
Hospital Charge Code	14203
Hospital Revenue Code	636
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$142.43
Rate for Payer: Aetna Commercial	$134.52
Rate for Payer: Aetna Medicare	$79.13
Rate for Payer: Aetna New Business (MI Preferred)	$102.87
Rate for Payer: BCBS Complete	$63.30
Rate for Payer: BCBS Trust/PPO	$21.43
Rate for Payer: BCN Commercial	$21.43
Rate for Payer: Cash Price	$126.61
Rate for Payer: Cash Price	$126.61
Rate for Payer: Cofinity Commercial	$110.78
Rate for Payer: Cofinity Commercial	$136.10
Rate for Payer: Cofinity Medicare Advantage	$110.78
Rate for Payer: Encore Health Key Benefits Commercial	$126.61
Rate for Payer: Healthscope Commercial	$142.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.52
Rate for Payer: PHP Commercial	$134.52
Rate for Payer: Priority Health Cigna Priority Health	$102.87
Rate for Payer: Priority Health SBD	$99.70

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION

Facility

$324.11

Service Code	HCPCS J9390
Hospital Charge Code	41673
Hospital Revenue Code	636
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$291.70
Rate for Payer: Aetna Commercial	$275.49
Rate for Payer: Aetna Medicare	$162.06
Rate for Payer: Aetna New Business (MI Preferred)	$210.67
Rate for Payer: BCBS Complete	$129.64
Rate for Payer: BCBS Trust/PPO	$21.43
Rate for Payer: BCN Commercial	$21.43
Rate for Payer: Cash Price	$259.29
Rate for Payer: Cash Price	$259.29
Rate for Payer: Cofinity Commercial	$226.88
Rate for Payer: Cofinity Commercial	$278.73
Rate for Payer: Cofinity Medicare Advantage	$226.88
Rate for Payer: Encore Health Key Benefits Commercial	$259.29
Rate for Payer: Healthscope Commercial	$291.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.49
Rate for Payer: PHP Commercial	$275.49
Rate for Payer: Priority Health Cigna Priority Health	$210.67
Rate for Payer: Priority Health SBD	$204.19

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET

Facility

$115.15

Service Code	NDC 60258016001
Hospital Charge Code	29833
Hospital Revenue Code	637
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Commercial	$80.60
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Cofinity Medicare Advantage	$80.60
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health Cigna Priority Health	$74.85
Rate for Payer: Priority Health SBD	$72.54

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET

Facility

$103.40

Service Code	NDC 00536730001
Hospital Charge Code	29833
Hospital Revenue Code	637
Min. Negotiated Rate	$41.36
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 Commercial	$72.38
Rate for Payer: Cofinity Commercial	$88.92
Rate for Payer: Cofinity Medicare Advantage	$72.38
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: PHP Commercial	$87.89
Rate for Payer: Priority Health Cigna Priority Health	$67.21
Rate for Payer: Priority Health SBD	$65.14

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET

Facility

$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 Commercial	$72.38
Rate for Payer: Cofinity Commercial	$88.92
Rate for Payer: Cofinity Medicare Advantage	$72.38
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: PHP Commercial	$87.89
Rate for Payer: Priority Health Cigna Priority Health	$67.21
Rate for Payer: Priority Health SBD	$65.14

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET

Facility

$115.15

Service Code	NDC 60258016001
Hospital Charge Code	29833
Hospital Revenue Code	637
Min. Negotiated Rate	$46.06
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna Medicare	$57.58
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: BCBS Complete	$46.06
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Commercial	$80.60
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Cofinity Medicare Advantage	$80.60
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health Cigna Priority Health	$74.85
Rate for Payer: Priority Health SBD	$72.54

VITAMIN B COMPLEX WITH C NO.10-FOLIC ACID 900 MCG/5 ML ORAL LIQUID

Facility

$395.44

Service Code	NDC 54859051608
Hospital Charge Code	32716
Hospital Revenue Code	637
Min. Negotiated Rate	$158.18
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 Commercial	$276.81
Rate for Payer: Cofinity Commercial	$340.08
Rate for Payer: Cofinity Medicare Advantage	$276.81
Rate for Payer: Encore Health Key Benefits Commercial	$316.35
Rate for Payer: Healthscope Commercial	$355.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.12
Rate for Payer: PHP Commercial	$336.12
Rate for Payer: Priority Health Cigna Priority Health	$257.04
Rate for Payer: Priority Health SBD	$249.13

VITAMIN B COMPLEX WITH C NO.10-FOLIC ACID 900 MCG/5 ML ORAL LIQUID

Facility

$395.44

Service Code	NDC 54859051608
Hospital Charge Code	32716
Hospital Revenue Code	637
Min. Negotiated Rate	$249.13
Max. Negotiated Rate	$355.90
Rate for Payer: Aetna Commercial	$336.12
Rate for Payer: Aetna New Business (MI Preferred)	$257.04
Rate for Payer: Cash Price	$316.35
Rate for Payer: Cofinity Commercial	$276.81
Rate for Payer: Cofinity Commercial	$340.08
Rate for Payer: Cofinity Medicare Advantage	$276.81
Rate for Payer: Encore Health Key Benefits Commercial	$316.35
Rate for Payer: Healthscope Commercial	$355.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.12
Rate for Payer: PHP Commercial	$336.12
Rate for Payer: Priority Health Cigna Priority Health	$257.04
Rate for Payer: Priority Health SBD	$249.13

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$179.30

Service Code	NDC 77333095110
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$161.37
Rate for Payer: Aetna Commercial	$152.40
Rate for Payer: Aetna Medicare	$89.65
Rate for Payer: Aetna New Business (MI Preferred)	$116.54
Rate for Payer: BCBS Complete	$71.72
Rate for Payer: Cash Price	$143.44
Rate for Payer: Cofinity Commercial	$125.51
Rate for Payer: Cofinity Commercial	$154.20
Rate for Payer: Cofinity Medicare Advantage	$125.51
Rate for Payer: Encore Health Key Benefits Commercial	$143.44
Rate for Payer: Healthscope Commercial	$161.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.40
Rate for Payer: PHP Commercial	$152.40
Rate for Payer: Priority Health Cigna Priority Health	$116.54
Rate for Payer: Priority Health SBD	$112.96

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$236.00

Service Code	NDC 80681000800
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$148.68
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Cofinity Medicare Advantage	$165.20
Rate for Payer: Encore Health Key Benefits Commercial	$188.80
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.60
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$153.40
Rate for Payer: Priority Health SBD	$148.68

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$1.80

Service Code	NDC 77333095125
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare	$0.90
Rate for Payer: Aetna New Business (MI Preferred)	$1.17
Rate for Payer: BCBS Complete	$0.72
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Commercial	$1.55
Rate for Payer: Cofinity Medicare Advantage	$1.26
Rate for Payer: Encore Health Key Benefits Commercial	$1.44
Rate for Payer: Healthscope Commercial	$1.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.53
Rate for Payer: PHP Commercial	$1.53
Rate for Payer: Priority Health Cigna Priority Health	$1.17
Rate for Payer: Priority Health SBD	$1.13

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$1.80

Service Code	NDC 77333095125
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna New Business (MI Preferred)	$1.17
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Commercial	$1.55
Rate for Payer: Cofinity Medicare Advantage	$1.26
Rate for Payer: Encore Health Key Benefits Commercial	$1.44
Rate for Payer: Healthscope Commercial	$1.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.53
Rate for Payer: PHP Commercial	$1.53
Rate for Payer: Priority Health Cigna Priority Health	$1.17
Rate for Payer: Priority Health SBD	$1.13

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$179.30

Service Code	NDC 77333095110
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$112.96
Max. Negotiated Rate	$161.37
Rate for Payer: Aetna Commercial	$152.40
Rate for Payer: Aetna New Business (MI Preferred)	$116.54
Rate for Payer: Cash Price	$143.44
Rate for Payer: Cofinity Commercial	$125.51
Rate for Payer: Cofinity Commercial	$154.20
Rate for Payer: Cofinity Medicare Advantage	$125.51
Rate for Payer: Encore Health Key Benefits Commercial	$143.44
Rate for Payer: Healthscope Commercial	$161.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.40
Rate for Payer: PHP Commercial	$152.40
Rate for Payer: Priority Health Cigna Priority Health	$116.54
Rate for Payer: Priority Health SBD	$112.96

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE

Facility

$236.00

Service Code	NDC 80681000800
Hospital Charge Code	118622
Hospital Revenue Code	637
Min. Negotiated Rate	$94.40
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna Medicare	$118.00
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: BCBS Complete	$94.40
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Cofinity Medicare Advantage	$165.20
Rate for Payer: Encore Health Key Benefits Commercial	$188.80
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.60
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$153.40
Rate for Payer: Priority Health SBD	$148.68

VIVONEX RTF BOLUS FEED

Facility

$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 Commercial	$31.08
Rate for Payer: Cofinity Commercial	$38.18
Rate for Payer: Cofinity Medicare Advantage	$31.08
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: PHP Commercial	$37.74
Rate for Payer: Priority Health Cigna Priority Health	$28.86
Rate for Payer: Priority Health SBD	$27.97

VIVONEX RTF BOLUS FEED

Facility

$59.20

Service Code	NDC 43900036280
Hospital Charge Code	150771
Hospital Revenue Code	637
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$53.28
Rate for Payer: Aetna Commercial	$50.32
Rate for Payer: Aetna Medicare	$29.60
Rate for Payer: Aetna New Business (MI Preferred)	$38.48
Rate for Payer: BCBS Complete	$23.68
Rate for Payer: Cash Price	$47.36
Rate for Payer: Cofinity Commercial	$41.44
Rate for Payer: Cofinity Commercial	$50.91
Rate for Payer: Cofinity Medicare Advantage	$41.44
Rate for Payer: Encore Health Key Benefits Commercial	$47.36
Rate for Payer: Healthscope Commercial	$53.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.32
Rate for Payer: PHP Commercial	$50.32
Rate for Payer: Priority Health Cigna Priority Health	$38.48
Rate for Payer: Priority Health SBD	$37.30

VIVONEX RTF BOLUS FEED

Facility

$59.20

Service Code	NDC 43900036280
Hospital Charge Code	150771
Hospital Revenue Code	637
Min. Negotiated Rate	$37.30
Max. Negotiated Rate	$53.28
Rate for Payer: Aetna Commercial	$50.32
Rate for Payer: Aetna New Business (MI Preferred)	$38.48
Rate for Payer: Cash Price	$47.36
Rate for Payer: Cofinity Commercial	$41.44
Rate for Payer: Cofinity Commercial	$50.91
Rate for Payer: Cofinity Medicare Advantage	$41.44
Rate for Payer: Encore Health Key Benefits Commercial	$47.36
Rate for Payer: Healthscope Commercial	$53.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.32
Rate for Payer: PHP Commercial	$50.32
Rate for Payer: Priority Health Cigna Priority Health	$38.48
Rate for Payer: Priority Health SBD	$37.30

VIVONEX RTF BOLUS FEED

Facility

$44.40

Service Code	NDC 00212362814
Hospital Charge Code	150771
Hospital Revenue Code	637
Min. Negotiated Rate	$17.76
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 Commercial	$31.08
Rate for Payer: Cofinity Commercial	$38.18
Rate for Payer: Cofinity Medicare Advantage	$31.08
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: PHP Commercial	$37.74
Rate for Payer: Priority Health Cigna Priority Health	$28.86
Rate for Payer: Priority Health SBD	$27.97

VIVONEX RTF CONTINUOUS FEED

Facility

$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 Commercial	$31.08
Rate for Payer: Cofinity Commercial	$38.18
Rate for Payer: Cofinity Medicare Advantage	$31.08
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: PHP Commercial	$37.74
Rate for Payer: Priority Health Cigna Priority Health	$28.86
Rate for Payer: Priority Health SBD	$27.97

VIVONEX RTF CONTINUOUS FEED

Facility

$59.20

Service Code	NDC 43900036280
Hospital Charge Code	168947
Hospital Revenue Code	637
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$53.28
Rate for Payer: Aetna Commercial	$50.32
Rate for Payer: Aetna Medicare	$29.60
Rate for Payer: Aetna New Business (MI Preferred)	$38.48
Rate for Payer: BCBS Complete	$23.68
Rate for Payer: Cash Price	$47.36
Rate for Payer: Cofinity Commercial	$41.44
Rate for Payer: Cofinity Commercial	$50.91
Rate for Payer: Cofinity Medicare Advantage	$41.44
Rate for Payer: Encore Health Key Benefits Commercial	$47.36
Rate for Payer: Healthscope Commercial	$53.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.32
Rate for Payer: PHP Commercial	$50.32
Rate for Payer: Priority Health Cigna Priority Health	$38.48
Rate for Payer: Priority Health SBD	$37.30

VIVONEX RTF CONTINUOUS FEED

Facility

$44.40

Service Code	NDC 00212362814
Hospital Charge Code	168947
Hospital Revenue Code	637
Min. Negotiated Rate	$17.76
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 Commercial	$31.08
Rate for Payer: Cofinity Commercial	$38.18
Rate for Payer: Cofinity Medicare Advantage	$31.08
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: PHP Commercial	$37.74
Rate for Payer: Priority Health Cigna Priority Health	$28.86
Rate for Payer: Priority Health SBD	$27.97

VIVONEX RTF CONTINUOUS FEED

Facility

$59.20

Service Code	NDC 43900036280
Hospital Charge Code	168947
Hospital Revenue Code	637
Min. Negotiated Rate	$37.30
Max. Negotiated Rate	$53.28
Rate for Payer: Aetna Commercial	$50.32
Rate for Payer: Aetna New Business (MI Preferred)	$38.48
Rate for Payer: Cash Price	$47.36
Rate for Payer: Cofinity Commercial	$41.44
Rate for Payer: Cofinity Commercial	$50.91
Rate for Payer: Cofinity Medicare Advantage	$41.44
Rate for Payer: Encore Health Key Benefits Commercial	$47.36
Rate for Payer: Healthscope Commercial	$53.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.32
Rate for Payer: PHP Commercial	$50.32
Rate for Payer: Priority Health Cigna Priority Health	$38.48
Rate for Payer: Priority Health SBD	$37.30

VIVONEX RTF CYCLIC FEED

Facility

$44.40

Service Code	NDC 00212362814
Hospital Charge Code	200089
Hospital Revenue Code	637
Min. Negotiated Rate	$17.76
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 Commercial	$31.08
Rate for Payer: Cofinity Commercial	$38.18
Rate for Payer: Cofinity Medicare Advantage	$31.08
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: PHP Commercial	$37.74
Rate for Payer: Priority Health Cigna Priority Health	$28.86
Rate for Payer: Priority Health SBD	$27.97

Know your out-of-pocket cost for care.

All Charges