|
ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$3,125.64
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
10358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,969.15 |
| Max. Negotiated Rate |
$2,813.08 |
| Rate for Payer: Aetna Commercial |
$2,656.79
|
| Rate for Payer: Aetna Commercial |
$1,039.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.67
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cofinity Advantage |
$2,187.95
|
| Rate for Payer: Cofinity Advantage |
$856.12
|
| Rate for Payer: Cofinity Commercial |
$1,051.81
|
| Rate for Payer: Cofinity Commercial |
$2,688.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.51
|
| Rate for Payer: Healthscope Commercial |
$1,100.73
|
| Rate for Payer: Healthscope Commercial |
$2,813.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,344.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$917.27
|
| Rate for Payer: PHP Commercial |
$1,039.58
|
| Rate for Payer: PHP Commercial |
$2,656.79
|
| Rate for Payer: Priority Health SBD |
$770.51
|
| Rate for Payer: Priority Health SBD |
$1,969.15
|
|
|
ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$3,125.64
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
10358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$2,813.08 |
| Rate for Payer: Aetna Commercial |
$2,656.79
|
| Rate for Payer: Aetna Commercial |
$1,039.58
|
| Rate for Payer: Aetna Medicare |
$10.70
|
| Rate for Payer: Aetna Medicare |
$10.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.86
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: BCBS MAPPO |
$10.29
|
| Rate for Payer: BCBS MAPPO |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$6.65
|
| Rate for Payer: BCBS Trust/PPO |
$6.65
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: BCN Commercial |
$6.65
|
| Rate for Payer: BCN Medicare Advantage |
$10.29
|
| Rate for Payer: BCN Medicare Advantage |
$10.29
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$978.42
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cash Price |
$2,500.51
|
| Rate for Payer: Cofinity Advantage |
$2,187.95
|
| Rate for Payer: Cofinity Advantage |
$856.12
|
| Rate for Payer: Cofinity Commercial |
$2,688.05
|
| Rate for Payer: Cofinity Commercial |
$1,051.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.29
|
| Rate for Payer: Healthscope Commercial |
$1,100.73
|
| Rate for Payer: Healthscope Commercial |
$2,813.08
|
| Rate for Payer: Mclaren Medicaid |
$5.38
|
| Rate for Payer: Mclaren Medicaid |
$5.38
|
| Rate for Payer: Mclaren Medicare |
$10.29
|
| Rate for Payer: Mclaren Medicare |
$10.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.80
|
| Rate for Payer: Meridian Medicaid |
$10.80
|
| Rate for Payer: Meridian Medicaid |
$10.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,656.79
|
| Rate for Payer: Nomi Health Commercial |
$30.87
|
| Rate for Payer: Nomi Health Commercial |
$30.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,344.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$917.27
|
| Rate for Payer: PACE Medicare |
$9.78
|
| Rate for Payer: PACE Medicare |
$9.78
|
| Rate for Payer: PACE SWMI |
$10.29
|
| Rate for Payer: PACE SWMI |
$10.29
|
| Rate for Payer: PHP Commercial |
$1,039.58
|
| Rate for Payer: PHP Commercial |
$2,656.79
|
| Rate for Payer: PHP Medicare Advantage |
$10.29
|
| Rate for Payer: PHP Medicare Advantage |
$10.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$10.29
|
| Rate for Payer: Priority Health Medicare |
$10.29
|
| Rate for Payer: Priority Health SBD |
$1,969.15
|
| Rate for Payer: Priority Health SBD |
$770.51
|
| Rate for Payer: Priority Health Tiered Network |
$22.01
|
| Rate for Payer: Priority Health Tiered Network |
$22.01
|
| Rate for Payer: Railroad Medicare Medicare |
$10.29
|
| Rate for Payer: Railroad Medicare Medicare |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.19
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Core |
$16.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.29
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Medicaid |
$5.38
|
| Rate for Payer: UHC Medicaid |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$5.38
|
| Rate for Payer: VA VA |
$10.29
|
| Rate for Payer: VA VA |
$10.29
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
IP
|
$223.20
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Advantage |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.40
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health SBD |
$140.62
|
|
|
ITRACONAZOLE 100 MG CAPSULE
|
Facility
|
OP
|
$223.20
|
|
|
Service Code
|
NDC 67877045430
|
| Hospital Charge Code |
10364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$200.88 |
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna Medicare |
$111.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.08
|
| Rate for Payer: BCBS Complete |
$89.28
|
| Rate for Payer: Cash Price |
$178.56
|
| Rate for Payer: Cofinity Advantage |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$191.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.56
|
| Rate for Payer: Healthscope Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.40
|
| Rate for Payer: PHP Commercial |
$189.72
|
| Rate for Payer: Priority Health SBD |
$140.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.08
|
| Rate for Payer: UHC Core |
$116.29
|
| Rate for Payer: UHC Exchange |
$87.72
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$464.37 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna Medicare |
$590.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: BCBS Complete |
$472.64
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Advantage |
$827.12
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$945.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$886.20
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health SBD |
$744.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$768.04
|
| Rate for Payer: UHC Core |
$615.61
|
| Rate for Payer: UHC Exchange |
$464.37
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,181.60
|
|
|
Service Code
|
NDC 50458029515
|
| Hospital Charge Code |
19928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$744.41 |
| Max. Negotiated Rate |
$1,063.44 |
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.04
|
| Rate for Payer: Cash Price |
$945.28
|
| Rate for Payer: Cofinity Advantage |
$827.12
|
| Rate for Payer: Cofinity Commercial |
$1,016.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$886.20
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: Priority Health SBD |
$744.41
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna Medicare |
$145.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.69
|
| Rate for Payer: BCBS Complete |
$76.75
|
| Rate for Payer: BCBS MAPPO |
$139.75
|
| Rate for Payer: BCBS Trust/PPO |
$351.16
|
| Rate for Payer: BCN Commercial |
$351.16
|
| Rate for Payer: BCN Medicare Advantage |
$139.75
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Advantage |
$6,331.77
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.75
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Mclaren Medicaid |
$73.09
|
| Rate for Payer: Mclaren Medicare |
$139.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.74
|
| Rate for Payer: Meridian Medicaid |
$146.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$153.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: Nomi Health Commercial |
$419.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,784.03
|
| Rate for Payer: PACE Medicare |
$132.76
|
| Rate for Payer: PACE SWMI |
$139.75
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: PHP Medicare Advantage |
$139.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.08
|
| Rate for Payer: Priority Health Medicare |
$139.75
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
| Rate for Payer: Priority Health Tiered Network |
$351.26
|
| Rate for Payer: Railroad Medicare Medicare |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.97
|
| Rate for Payer: UHC Core |
$230.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$139.75
|
| Rate for Payer: UHC Exchange |
$230.97
|
| Rate for Payer: UHC Medicaid |
$73.09
|
| Rate for Payer: UHCCP Medicaid |
$73.09
|
| Rate for Payer: VA VA |
$139.75
|
|
|
IXABEPILONE 15 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,045.38
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
88652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,698.59 |
| Max. Negotiated Rate |
$8,140.84 |
| Rate for Payer: Aetna Commercial |
$7,688.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,879.50
|
| Rate for Payer: Cash Price |
$7,236.30
|
| Rate for Payer: Cofinity Advantage |
$6,331.77
|
| Rate for Payer: Cofinity Commercial |
$7,779.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,236.30
|
| Rate for Payer: Healthscope Commercial |
$8,140.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,784.03
|
| Rate for Payer: PHP Commercial |
$7,688.57
|
| Rate for Payer: Priority Health SBD |
$5,698.59
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 09900000400
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.08
|
| Rate for Payer: UHC Exchange |
$1.57
|
|
|
J-TIP NEEDLE FREE INJECTOR 0.25 ML
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 09900000400
|
| Hospital Charge Code |
163515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
|
|
KATE FARMS BOLUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
|
|
KATE FARMS CONTINUOUS FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
|
|
KATE FARMS CYCLIC FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
|
|
KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 09900001990
|
| Hospital Charge Code |
301453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 11112003042
|
| Hospital Charge Code |
301453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
|
