|
VILAZODONE 20 MG TABLET
|
Facility
IP
|
$1,195.03
|
|
|
Service Code
|
NDC 0456-1120-30
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$752.87 |
| Max. Negotiated Rate |
$1,075.53 |
| Rate for Payer: Aetna Commercial |
$1,015.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.77
|
| Rate for Payer: Cash Price |
$956.02
|
| Rate for Payer: Cofinity Commercial |
$1,027.73
|
| Rate for Payer: Cofinity Commercial |
$836.52
|
| Rate for Payer: Healthscope Commercial |
$1,075.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.78
|
| Rate for Payer: PHP Commercial |
$1,015.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.52
|
| Rate for Payer: Priority Health SBD |
$752.87
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: BCBS Complete |
$202.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Commercial |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.19
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.10
|
| Rate for Payer: Priority Health SBD |
$319.59
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$319.59 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Commercial |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.19
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.10
|
| Rate for Payer: Priority Health SBD |
$319.59
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$22.87
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$190.65
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.11 |
| Max. Negotiated Rate |
$171.58 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.92
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$171.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.05
|
| Rate for Payer: PHP Commercial |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.46
|
| Rate for Payer: Priority Health SBD |
$120.11
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$190.65
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$171.58 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.92
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS Trust/PPO |
$22.87
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$171.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.05
|
| Rate for Payer: PHP Commercial |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.46
|
| Rate for Payer: Priority Health SBD |
$120.11
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$158.26
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.94 |
| 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: BCBS Complete |
$63.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.94
|
| 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: Healthscope Commercial |
$142.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.52
|
| Rate for Payer: PHP Commercial |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.78
|
| Rate for Payer: Priority Health SBD |
$99.70
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$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: Healthscope Commercial |
$142.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.52
|
| Rate for Payer: PHP Commercial |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.78
|
| Rate for Payer: Priority Health SBD |
$99.70
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$324.11
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Aetna Commercial |
$275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.67
|
| Rate for Payer: BCBS Complete |
$129.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.94
|
| 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: Healthscope Commercial |
$291.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.49
|
| Rate for Payer: PHP Commercial |
$275.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.88
|
| Rate for Payer: Priority Health SBD |
$204.19
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
IP
|
$25,015.03
|
|
|
Service Code
|
MS-DRG 865
|
| Min. Negotiated Rate |
$11,687.79 |
| Max. Negotiated Rate |
$25,015.03 |
| Rate for Payer: Aetna Medicare |
$12,795.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,378.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,378.68
|
| Rate for Payer: BCBS MAPPO |
$12,302.94
|
| Rate for Payer: BCBS Trust/PPO |
$22,325.72
|
| Rate for Payer: BCN Medicare Advantage |
$12,302.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,302.94
|
| Rate for Payer: Mclaren Medicare |
$12,302.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,918.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,148.38
|
| Rate for Payer: PACE Medicare |
$11,687.79
|
| Rate for Payer: PACE SWMI |
$12,302.94
|
| Rate for Payer: PHP Medicare Advantage |
$12,302.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,532.43
|
| Rate for Payer: Priority Health Medicare |
$12,302.94
|
| Rate for Payer: Priority Health Narrow Network |
$18,825.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12,302.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,015.03
|
| Rate for Payer: UHC Core |
$15,349.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,302.94
|
| Rate for Payer: UHC Exchange |
$16,440.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,672.03
|
| Rate for Payer: VA VA |
$12,302.94
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
IP
|
$13,998.60
|
|
|
Service Code
|
MS-DRG 866
|
| Min. Negotiated Rate |
$6,746.72 |
| Max. Negotiated Rate |
$13,998.60 |
| Rate for Payer: Aetna Medicare |
$7,385.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,877.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,877.26
|
| Rate for Payer: BCBS MAPPO |
$7,101.81
|
| Rate for Payer: BCBS Trust/PPO |
$10,059.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,101.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,101.81
|
| Rate for Payer: Mclaren Medicare |
$7,101.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,456.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,167.08
|
| Rate for Payer: PACE Medicare |
$6,746.72
|
| Rate for Payer: PACE SWMI |
$7,101.81
|
| Rate for Payer: PHP Medicare Advantage |
$7,101.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,168.92
|
| Rate for Payer: Priority Health Medicare |
$7,101.81
|
| Rate for Payer: Priority Health Narrow Network |
$10,535.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7,101.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,998.60
|
| Rate for Payer: UHC Core |
$8,589.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,101.81
|
| Rate for Payer: UHC Exchange |
$9,199.94
|
| Rate for Payer: UHC Medicare Advantage |
$7,314.86
|
| Rate for Payer: VA VA |
$7,101.81
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
IP
|
$29,193.11
|
|
|
Service Code
|
MS-DRG 075
|
| Min. Negotiated Rate |
$13,561.75 |
| Max. Negotiated Rate |
$29,193.11 |
| Rate for Payer: Aetna Medicare |
$14,846.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,844.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,844.41
|
| Rate for Payer: BCBS MAPPO |
$14,275.53
|
| Rate for Payer: BCBS Trust/PPO |
$16,844.75
|
| Rate for Payer: BCN Medicare Advantage |
$14,275.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,275.53
|
| Rate for Payer: Mclaren Medicare |
$14,275.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,989.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,416.86
|
| Rate for Payer: PACE Medicare |
$13,561.75
|
| Rate for Payer: PACE SWMI |
$14,275.53
|
| Rate for Payer: PHP Medicare Advantage |
$14,275.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,462.88
|
| Rate for Payer: Priority Health Medicare |
$14,275.53
|
| Rate for Payer: Priority Health Narrow Network |
$21,970.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14,275.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,193.11
|
| Rate for Payer: UHC Core |
$17,913.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,275.53
|
| Rate for Payer: UHC Exchange |
$19,185.85
|
| Rate for Payer: UHC Medicare Advantage |
$14,703.80
|
| Rate for Payer: VA VA |
$14,275.53
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
IP
|
$14,071.82
|
|
|
Service Code
|
MS-DRG 076
|
| Min. Negotiated Rate |
$6,779.56 |
| Max. Negotiated Rate |
$14,071.82 |
| Rate for Payer: Aetna Medicare |
$7,421.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,920.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,920.48
|
| Rate for Payer: BCBS MAPPO |
$7,136.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,745.40
|
| Rate for Payer: BCN Medicare Advantage |
$7,136.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,136.38
|
| Rate for Payer: Mclaren Medicare |
$7,136.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,493.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,206.84
|
| Rate for Payer: PACE Medicare |
$6,779.56
|
| Rate for Payer: PACE SWMI |
$7,136.38
|
| Rate for Payer: PHP Medicare Advantage |
$7,136.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,237.80
|
| Rate for Payer: Priority Health Medicare |
$7,136.38
|
| Rate for Payer: Priority Health Narrow Network |
$10,590.24
|
| Rate for Payer: Railroad Medicare Medicare |
$7,136.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,071.82
|
| Rate for Payer: UHC Core |
$8,634.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,136.38
|
| Rate for Payer: UHC Exchange |
$9,248.06
|
| Rate for Payer: UHC Medicare Advantage |
$7,350.47
|
| Rate for Payer: VA VA |
$7,136.38
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
IP
|
$103.40
|
|
|
Service Code
|
NDC 536730001
|
| 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: Healthscope Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
IP
|
$138.65
|
|
|
Service Code
|
NDC 6025816001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.35 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health SBD |
$87.35
|
|
|
VITAMIN B COMPLEX WITH C NO.10-FOLIC ACID 900 MCG/5 ML ORAL LIQUID
|
Facility
IP
|
$395.44
|
|
|
Service Code
|
NDC 5485951608
|
| 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 |
$340.08
|
| Rate for Payer: Cofinity Commercial |
$276.81
|
| Rate for Payer: Healthscope Commercial |
$355.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.12
|
| Rate for Payer: PHP Commercial |
$336.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.81
|
| Rate for Payer: Priority Health SBD |
$249.13
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$1.75
|
|
|
Service Code
|
NDC 7733395125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.22
|
| Rate for Payer: Priority Health SBD |
$1.10
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$236.00
|
|
|
Service Code
|
NDC 8068100800
|
| 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: Healthscope Commercial |
$212.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
| Rate for Payer: PHP Commercial |
$200.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health SBD |
$148.68
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$174.90
|
|
|
Service Code
|
NDC 7733395110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.68
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.66
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.43
|
| Rate for Payer: Priority Health SBD |
$110.19
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
IP
|
$59.20
|
|
|
Service Code
|
NDC 4390036280
|
| 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: Healthscope Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.44
|
| Rate for Payer: Priority Health SBD |
$37.30
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
IP
|
$44.40
|
|
|
Service Code
|
NDC 0212-3628-14
|
| 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: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.74
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
IP
|
$59.20
|
|
|
Service Code
|
NDC 4390036280
|
| 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: Healthscope Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.44
|
| Rate for Payer: Priority Health SBD |
$37.30
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
IP
|
$44.40
|
|
|
Service Code
|
NDC 0212-3628-14
|
| 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: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.74
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
IP
|
$59.20
|
|
|
Service Code
|
NDC 4390036280
|
| Hospital Charge Code |
200089
|
|
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: Healthscope Commercial |
$53.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.32
|
| Rate for Payer: PHP Commercial |
$50.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.44
|
| Rate for Payer: Priority Health SBD |
$37.30
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
IP
|
$44.40
|
|
|
Service Code
|
NDC 0212-3628-14
|
| 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 Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.74
|
| Rate for Payer: PHP Commercial |
$37.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: Priority Health SBD |
$27.97
|
|
