|
VIRAL ILLNESS
|
Facility
|
IP
|
$2,575.98
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$2,328.99 |
| Max. Negotiated Rate |
$2,575.98 |
| Rate for Payer: BCBS Complete |
$2,575.98
|
| Rate for Payer: Mclaren Medicaid |
$2,453.31
|
| Rate for Payer: Meridian Medicaid |
$2,575.98
|
| Rate for Payer: PHP Medicaid |
$2,328.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,453.31
|
| Rate for Payer: UHC Medicaid |
$2,453.31
|
| Rate for Payer: UHCCP Medicaid |
$2,453.31
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$20,584.84
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,916.88 |
| Max. Negotiated Rate |
$20,584.84 |
| Rate for Payer: Aetna Medicare |
$12,544.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,680.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,680.10
|
| Rate for Payer: BCBS MAPPO |
$12,544.08
|
| Rate for Payer: BCN Medicare Advantage |
$12,544.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,544.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,544.08
|
| Rate for Payer: Mclaren Medicare |
$12,544.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,171.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,425.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,798.49
|
| Rate for Payer: PACE Medicare |
$11,916.88
|
| Rate for Payer: PACE SWMI |
$12,544.08
|
| Rate for Payer: PHP Commercial |
$13,798.49
|
| Rate for Payer: PHP Medicare Advantage |
$12,544.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,584.84
|
| Rate for Payer: Priority Health Medicare |
$12,544.08
|
| Rate for Payer: Priority Health Narrow Network |
$16,467.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,544.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,544.08
|
| Rate for Payer: UHC Exchange |
$19,443.32
|
| Rate for Payer: UHCCP DNSP |
$12,544.08
|
| Rate for Payer: VA VA |
$12,544.08
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$12,425.82
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$7,615.83 |
| Max. Negotiated Rate |
$12,425.82 |
| Rate for Payer: Aetna Medicare |
$8,016.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,020.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,020.83
|
| Rate for Payer: BCBS MAPPO |
$8,016.66
|
| Rate for Payer: BCN Medicare Advantage |
$8,016.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,016.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,016.66
|
| Rate for Payer: Mclaren Medicare |
$8,016.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,417.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,219.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,818.33
|
| Rate for Payer: PACE Medicare |
$7,615.83
|
| Rate for Payer: PACE SWMI |
$8,016.66
|
| Rate for Payer: PHP Commercial |
$8,818.33
|
| Rate for Payer: PHP Medicare Advantage |
$8,016.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,947.26
|
| Rate for Payer: Priority Health Medicare |
$8,016.66
|
| Rate for Payer: Priority Health Narrow Network |
$9,557.81
|
| Rate for Payer: Railroad Medicare Medicare |
$8,016.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,016.66
|
| Rate for Payer: UHC Exchange |
$12,425.82
|
| Rate for Payer: UHCCP DNSP |
$8,016.66
|
| Rate for Payer: VA VA |
$8,016.66
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$10,785.11
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$9,751.03 |
| Max. Negotiated Rate |
$10,785.11 |
| Rate for Payer: BCBS Complete |
$10,785.11
|
| Rate for Payer: Mclaren Medicaid |
$10,271.53
|
| Rate for Payer: Meridian Medicaid |
$10,785.11
|
| Rate for Payer: PHP Medicaid |
$9,751.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,271.53
|
| Rate for Payer: UHC Medicaid |
$10,271.53
|
| Rate for Payer: UHCCP Medicaid |
$10,271.53
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$4,125.27
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$3,729.74 |
| Max. Negotiated Rate |
$4,125.27 |
| Rate for Payer: BCBS Complete |
$4,125.27
|
| Rate for Payer: Mclaren Medicaid |
$3,928.83
|
| Rate for Payer: Meridian Medicaid |
$4,125.27
|
| Rate for Payer: PHP Medicaid |
$3,729.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,928.83
|
| Rate for Payer: UHC Medicaid |
$3,928.83
|
| Rate for Payer: UHCCP Medicaid |
$3,928.83
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$3,070.79
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$2,776.36 |
| Max. Negotiated Rate |
$3,070.79 |
| Rate for Payer: BCBS Complete |
$3,070.79
|
| Rate for Payer: Mclaren Medicaid |
$2,924.57
|
| Rate for Payer: Meridian Medicaid |
$3,070.79
|
| Rate for Payer: PHP Medicaid |
$2,776.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,924.57
|
| Rate for Payer: UHC Medicaid |
$2,924.57
|
| Rate for Payer: UHCCP Medicaid |
$2,924.57
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$6,809.70
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$6,156.78 |
| Max. Negotiated Rate |
$6,809.70 |
| Rate for Payer: BCBS Complete |
$6,809.70
|
| Rate for Payer: Mclaren Medicaid |
$6,485.42
|
| Rate for Payer: Meridian Medicaid |
$6,809.70
|
| Rate for Payer: PHP Medicaid |
$6,156.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,485.42
|
| Rate for Payer: UHC Medicaid |
$6,485.42
|
| Rate for Payer: UHCCP Medicaid |
$6,485.42
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$26,344.15
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$14,784.71 |
| Max. Negotiated Rate |
$26,344.15 |
| Rate for Payer: Aetna Medicare |
$15,562.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,453.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,453.56
|
| Rate for Payer: BCBS MAPPO |
$15,562.85
|
| Rate for Payer: BCN Medicare Advantage |
$15,562.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,562.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,562.85
|
| Rate for Payer: Mclaren Medicare |
$15,562.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,340.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,897.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,119.13
|
| Rate for Payer: PACE Medicare |
$14,784.71
|
| Rate for Payer: PACE SWMI |
$15,562.85
|
| Rate for Payer: PHP Commercial |
$17,119.13
|
| Rate for Payer: PHP Medicare Advantage |
$15,562.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,344.15
|
| Rate for Payer: Priority Health Medicare |
$15,562.85
|
| Rate for Payer: Priority Health Narrow Network |
$21,075.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15,562.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,562.85
|
| Rate for Payer: UHC Exchange |
$24,122.42
|
| Rate for Payer: UHCCP DNSP |
$15,562.85
|
| Rate for Payer: VA VA |
$15,562.85
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,930.24
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$7,312.08 |
| Max. Negotiated Rate |
$11,930.24 |
| Rate for Payer: Aetna Medicare |
$7,696.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,621.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,621.16
|
| Rate for Payer: BCBS MAPPO |
$7,696.93
|
| Rate for Payer: BCN Medicare Advantage |
$7,696.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,696.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,696.93
|
| Rate for Payer: Mclaren Medicare |
$7,696.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,081.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,851.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,466.62
|
| Rate for Payer: PACE Medicare |
$7,312.08
|
| Rate for Payer: PACE SWMI |
$7,696.93
|
| Rate for Payer: PHP Commercial |
$8,466.62
|
| Rate for Payer: PHP Medicare Advantage |
$7,696.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,337.26
|
| Rate for Payer: Priority Health Medicare |
$7,696.93
|
| Rate for Payer: Priority Health Narrow Network |
$9,069.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7,696.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,696.93
|
| Rate for Payer: UHC Exchange |
$11,930.24
|
| Rate for Payer: UHCCP DNSP |
$7,696.93
|
| Rate for Payer: VA VA |
$7,696.93
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 61924020404
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$12.56
|
| Rate for Payer: BCN Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$14.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 61924020404
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$14.84
|
| Rate for Payer: Healthscope Whirlpool |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: ASR ASR |
$15.28
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCN Commercial |
$12.99
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Whirlpool |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$14.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.80
|
| Rate for Payer: Priority Health Narrow Network |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.86
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: ASR ASR |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$12.93
|
| Rate for Payer: BCN Commercial |
$12.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Whirlpool |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.86
|
|
|
VITAMIN B COMPLEX CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 536478701
|
| Hospital Charge Code |
804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$115.79
|
| Rate for Payer: BCN Commercial |
$115.79
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$136.77
|
| Rate for Payer: Healthscope Whirlpool |
$141.00
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
VITAMIN B COMPLEX CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 536478701
|
| Hospital Charge Code |
804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$52.17
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$116.25
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$136.77
|
| Rate for Payer: Healthscope Whirlpool |
$141.00
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$9.47
|
| Rate for Payer: Aetna Medicare |
$3.89
|
| Rate for Payer: ASR ASR |
$10.20
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| Rate for Payer: BCN Commercial |
$8.67
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$10.52
|
| Rate for Payer: Mclaren Commercial |
$9.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.22
|
| Rate for Payer: Priority Health Narrow Network |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.26
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$12.62
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: ASR ASR |
$12.24
|
| Rate for Payer: BCBS Complete |
$5.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.41
|
| Rate for Payer: BCN Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$12.62
|
| Rate for Payer: Mclaren Commercial |
$11.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.06
|
| Rate for Payer: Priority Health Narrow Network |
$8.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.11
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$9.47
|
| Rate for Payer: ASR ASR |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$8.64
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$10.52
|
| Rate for Payer: Mclaren Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.26
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$12.62
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: ASR ASR |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Commercial |
$10.37
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$12.62
|
| Rate for Payer: Mclaren Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.11
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.92
|
| Rate for Payer: Priority Health Narrow Network |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,371.11 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: Aetna Medicare |
$2,371.11
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Complete |
$2,563.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,283.73
|
| Rate for Payer: BCN Commercial |
$5,283.73
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,615.04
|
| Rate for Payer: Priority Health Narrow Network |
$4,492.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: ASR ASR |
$9.87
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Nomi Health Commercial |
$8.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.92
|
| Rate for Payer: Priority Health Narrow Network |
$7.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.95
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,806.30 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,262.58
|
| Rate for Payer: BCN Commercial |
$5,262.58
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,216.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,408.40
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,447.14
|
| Rate for Payer: Nomi Health Commercial |
$5,254.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,806.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
