|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.98
|
| Rate for Payer: Priority Health Narrow Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NOVASOURCE RENAL CONTINUOUS FEED
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
168945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.67
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NOVASOURCE RENAL CYCLIC FEED
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.67
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NOVASOURCE RENAL CYCLIC FEED
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.98
|
| Rate for Payer: Priority Health Narrow Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.98
|
| Rate for Payer: Priority Health Narrow Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NOVASOURCE RENAL INTERMITTENT FEED
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43900035111
|
| Hospital Charge Code |
200086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.67
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.83
|
| Rate for Payer: Nomi Health Commercial |
$4.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
NURSING CASE MANAGEMENT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS RN001
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
180645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
181405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 CYCLIC FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
200083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006220
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716016220
|
| Hospital Charge Code |
200082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
150720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
NUTREN 2.0 BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 98716006230
|
| Hospital Charge Code |
150720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.75
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
