|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 98716016354
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
|
|
NUTREN 2.0 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
150720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
NUTREN 2.0 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
150720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
NUTREN 2.0 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
168944
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
NUTREN 2.0 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
168944
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
NUTREN 2.0 CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
NUTREN 2.0 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
NUTREN 2.0 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
NUTREN 2.0 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
200084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
NUT.TX. COMPROMISED IMMUNE SYSTEM,REG 0.06 GRAM-1 KCAL/ML ORAL LIQUID
|
Facility
|
OP
|
$55.50
|
|
|
Service Code
|
NDC 00212358114
|
| Hospital Charge Code |
118217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: Aetna Medicare |
$27.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.08
|
| Rate for Payer: BCBS Complete |
$22.20
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cofinity Advantage |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$47.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.40
|
| Rate for Payer: Healthscope Commercial |
$49.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.62
|
| Rate for Payer: PHP Commercial |
$47.17
|
| Rate for Payer: Priority Health SBD |
$34.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.08
|
| Rate for Payer: UHC Core |
$28.92
|
| Rate for Payer: UHC Exchange |
$21.81
|
|
|
NUT.TX. COMPROMISED IMMUNE SYSTEM,REG 0.06 GRAM-1 KCAL/ML ORAL LIQUID
|
Facility
|
IP
|
$55.50
|
|
|
Service Code
|
NDC 00212358114
|
| Hospital Charge Code |
118217
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.08
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cofinity Advantage |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$47.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.40
|
| Rate for Payer: Healthscope Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.62
|
| Rate for Payer: PHP Commercial |
$47.17
|
| Rate for Payer: Priority Health SBD |
$34.97
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
IP
|
$18.16
|
|
|
Service Code
|
NDC 45802005935
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: Priority Health SBD |
$11.44
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM
|
Facility
|
OP
|
$18.16
|
|
|
Service Code
|
NDC 45802005935
|
| Hospital Charge Code |
5749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: Priority Health SBD |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.80
|
| Rate for Payer: UHC Core |
$9.46
|
| Rate for Payer: UHC Exchange |
$7.14
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.69
|
|
|
Service Code
|
NDC 00121086850
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.30
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cofinity Advantage |
$6.78
|
| Rate for Payer: Cofinity Commercial |
$8.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.27
|
| Rate for Payer: PHP Commercial |
$8.24
|
| Rate for Payer: Priority Health SBD |
$6.10
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 00121086840
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.44
|
| Rate for Payer: UHC Exchange |
$1.84
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Advantage |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health SBD |
$3.46
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 60687080017
|
| Hospital Charge Code |
5751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.13
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
|
