|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628001610
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$603.29 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.04 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna Medicare |
$478.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: BCBS Complete |
$383.04
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,055.52
|
|
|
Service Code
|
NDC 52536010810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$664.98 |
| Max. Negotiated Rate |
$949.97 |
| Rate for Payer: Aetna Commercial |
$897.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.09
|
| Rate for Payer: Cash Price |
$844.42
|
| Rate for Payer: Cofinity Commercial |
$738.86
|
| Rate for Payer: Cofinity Commercial |
$907.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.42
|
| Rate for Payer: Healthscope Commercial |
$949.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.19
|
| Rate for Payer: PHP Commercial |
$897.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.09
|
| Rate for Payer: Priority Health SBD |
$664.98
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628001610
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.10
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.97
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.10
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: BCBS Complete |
$22.84
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.97
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
OP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.15
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$1,343.88
|
|
|
Service Code
|
NDC 60687064821
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$846.64 |
| Max. Negotiated Rate |
$1,209.49 |
| Rate for Payer: Aetna Commercial |
$1,142.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.52
|
| Rate for Payer: Cash Price |
$1,075.10
|
| Rate for Payer: Cofinity Commercial |
$1,155.74
|
| Rate for Payer: Cofinity Commercial |
$940.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.10
|
| Rate for Payer: Healthscope Commercial |
$1,209.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.30
|
| Rate for Payer: PHP Commercial |
$1,142.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.52
|
| Rate for Payer: Priority Health SBD |
$846.64
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
NDC 60687064811
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.12
|
| Rate for Payer: BCBS Complete |
$17.92
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$31.36
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health SBD |
$28.22
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$1,343.88
|
|
|
Service Code
|
NDC 60687064821
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.55 |
| Max. Negotiated Rate |
$1,209.49 |
| Rate for Payer: Aetna Commercial |
$1,142.30
|
| Rate for Payer: Aetna Medicare |
$671.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.52
|
| Rate for Payer: BCBS Complete |
$537.55
|
| Rate for Payer: Cash Price |
$1,075.10
|
| Rate for Payer: Cofinity Commercial |
$1,155.74
|
| Rate for Payer: Cofinity Commercial |
$940.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.10
|
| Rate for Payer: Healthscope Commercial |
$1,209.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.30
|
| Rate for Payer: PHP Commercial |
$1,142.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.52
|
| Rate for Payer: Priority Health SBD |
$846.64
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
NDC 60687064811
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.12
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$31.36
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health SBD |
$28.22
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Medicare |
$46.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
IP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.77 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Medicare |
$26.86
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna Medicare |
$46.65
|
| Rate for Payer: Aetna Medicare |
$77.43
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: BCBS Complete |
$61.94
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Complete |
$21.49
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health SBD |
$61.53
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health SBD |
$33.85
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$120.17
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$108.15 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: Priority Health SBD |
$61.53
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$446.97
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$402.27 |
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$2.01
|
| Rate for Payer: Mclaren Medicare |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: PACE Medicare |
$1.91
|
| Rate for Payer: PACE Medicare |
$1.91
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health Medicare |
$2.01
|
| Rate for Payer: Priority Health Medicare |
$2.01
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Priority Health SBD |
$281.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$2.01
|
| Rate for Payer: VA VA |
$2.01
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.05 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Priority Health SBD |
$281.59
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,331.54 |
| Max. Negotiated Rate |
$21,902.19 |
| Rate for Payer: Aetna Commercial |
$20,685.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,818.25
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cofinity Commercial |
$17,035.04
|
| Rate for Payer: Cofinity Commercial |
$20,928.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,035.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Healthscope Commercial |
$21,902.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: PHP Commercial |
$20,685.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health SBD |
$15,331.54
|
|
