|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$120.20
|
|
|
Service Code
|
NDC 00121086720
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$108.18 |
| Rate for Payer: Aetna Commercial |
$102.17
|
| Rate for Payer: Aetna Medicare |
$31.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.56
|
| Rate for Payer: BCBS Complete |
$22.25
|
| Rate for Payer: BCBS MAPPO |
$30.05
|
| Rate for Payer: BCBS Trust/PPO |
$98.82
|
| Rate for Payer: BCN Commercial |
$98.82
|
| Rate for Payer: BCN Medicare Advantage |
$30.05
|
| Rate for Payer: Cash Price |
$96.16
|
| Rate for Payer: Cofinity Commercial |
$103.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$108.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.15
|
| Rate for Payer: Mclaren Medicaid |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.55
|
| Rate for Payer: Meridian Medicaid |
$22.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.17
|
| Rate for Payer: Nomi Health Commercial |
$98.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.15
|
| Rate for Payer: PACE Senior Care Partners |
$28.55
|
| Rate for Payer: PACE SWMI |
$30.05
|
| Rate for Payer: PHP Commercial |
$102.17
|
| Rate for Payer: PHP Medicare Advantage |
$30.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.57
|
| Rate for Payer: Priority Health Medicare |
$30.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.66
|
| Rate for Payer: Railroad Medicare Medicare |
$30.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.78
|
| Rate for Payer: UHC Core |
$100.37
|
| Rate for Payer: UHC Exchange |
$30.05
|
| Rate for Payer: UHC Medicaid |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$30.05
|
| Rate for Payer: UHCCP Medicaid |
$21.19
|
| Rate for Payer: VA VA |
$30.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.15
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
IP
|
$172.05
|
|
|
Service Code
|
NDC 62559039020
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$154.84 |
| Rate for Payer: Aetna Commercial |
$146.24
|
| Rate for Payer: BCBS Trust/PPO |
$142.10
|
| Rate for Payer: BCN Commercial |
$142.10
|
| Rate for Payer: Cash Price |
$137.64
|
| Rate for Payer: Cofinity Commercial |
$147.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.64
|
| Rate for Payer: Healthscope Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.24
|
| Rate for Payer: Nomi Health Commercial |
$141.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.04
|
| Rate for Payer: PHP Commercial |
$146.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$149.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.40
|
| Rate for Payer: UHC Core |
$143.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.04
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$172.05
|
|
|
Service Code
|
NDC 62559039020
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$154.84 |
| Rate for Payer: Aetna Commercial |
$146.24
|
| Rate for Payer: Aetna Medicare |
$44.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.77
|
| Rate for Payer: BCBS Complete |
$31.85
|
| Rate for Payer: BCBS MAPPO |
$43.01
|
| Rate for Payer: BCBS Trust/PPO |
$141.44
|
| Rate for Payer: BCN Commercial |
$141.44
|
| Rate for Payer: BCN Medicare Advantage |
$43.01
|
| Rate for Payer: Cash Price |
$137.64
|
| Rate for Payer: Cofinity Commercial |
$147.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.01
|
| Rate for Payer: Healthscope Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.04
|
| Rate for Payer: Mclaren Medicaid |
$30.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.16
|
| Rate for Payer: Meridian Medicaid |
$31.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.24
|
| Rate for Payer: Nomi Health Commercial |
$141.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.04
|
| Rate for Payer: PACE Senior Care Partners |
$40.86
|
| Rate for Payer: PACE SWMI |
$43.01
|
| Rate for Payer: PHP Commercial |
$146.24
|
| Rate for Payer: PHP Medicare Advantage |
$43.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$149.68
|
| Rate for Payer: Priority Health Medicare |
$43.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.75
|
| Rate for Payer: Railroad Medicare Medicare |
$43.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.40
|
| Rate for Payer: UHC Core |
$143.66
|
| Rate for Payer: UHC Exchange |
$43.01
|
| Rate for Payer: UHC Medicaid |
$30.33
|
| Rate for Payer: UHC Medicare Advantage |
$43.01
|
| Rate for Payer: UHCCP Medicaid |
$30.33
|
| Rate for Payer: VA VA |
$43.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.04
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
NDC 23155085878
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$101.09
|
| Rate for Payer: BCN Commercial |
$101.09
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.04
|
| Rate for Payer: Nomi Health Commercial |
$100.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.80
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.71
|
| Rate for Payer: UHC Core |
$102.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.80
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
NDC 23155085878
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.25
|
| Rate for Payer: BCBS Complete |
$22.66
|
| Rate for Payer: BCBS MAPPO |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$100.63
|
| Rate for Payer: BCN Commercial |
$100.63
|
| Rate for Payer: BCN Medicare Advantage |
$30.60
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$21.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.13
|
| Rate for Payer: Meridian Medicaid |
$22.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.04
|
| Rate for Payer: Nomi Health Commercial |
$100.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.80
|
| Rate for Payer: PACE Senior Care Partners |
$29.07
|
| Rate for Payer: PACE SWMI |
$30.60
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: PHP Medicare Advantage |
$30.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.49
|
| Rate for Payer: Priority Health Medicare |
$30.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.19
|
| Rate for Payer: Railroad Medicare Medicare |
$30.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.71
|
| Rate for Payer: UHC Core |
$102.20
|
| Rate for Payer: UHC Exchange |
$30.60
|
| Rate for Payer: UHC Medicaid |
$21.58
|
| Rate for Payer: UHC Medicare Advantage |
$30.60
|
| Rate for Payer: UHCCP Medicaid |
$21.58
|
| Rate for Payer: VA VA |
$30.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.80
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.37
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$46.23 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Medicare |
$13.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.05
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS MAPPO |
$12.84
|
| Rate for Payer: BCBS Trust/PPO |
$42.23
|
| Rate for Payer: BCN Commercial |
$42.23
|
| Rate for Payer: BCN Medicare Advantage |
$12.84
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$46.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.53
|
| Rate for Payer: Mclaren Medicaid |
$9.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Medicaid |
$9.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.53
|
| Rate for Payer: PACE Senior Care Partners |
$12.20
|
| Rate for Payer: PACE SWMI |
$12.84
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Medicare Advantage |
$12.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.21
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: UHC Exchange |
$12.84
|
| Rate for Payer: UHC Medicaid |
$9.06
|
| Rate for Payer: UHC Medicare Advantage |
$12.84
|
| Rate for Payer: UHCCP Medicaid |
$9.06
|
| Rate for Payer: VA VA |
$12.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.53
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Commercial |
$41.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Commercial |
$43.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.37
|
| Rate for Payer: Nomi Health Commercial |
$33.94
|
| Rate for Payer: Nomi Health Commercial |
$39.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.50
|
| Rate for Payer: PHP Commercial |
$41.37
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.83
|
| Rate for Payer: UHC Core |
$34.56
|
| Rate for Payer: UHC Core |
$40.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.50
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.37
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$46.23 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: BCBS Trust/PPO |
$42.43
|
| Rate for Payer: BCN Commercial |
$42.43
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.10
|
| Rate for Payer: Healthscope Commercial |
$46.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.53
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.21
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.53
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Commercial |
$41.37
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.21
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$9.01
|
| Rate for Payer: BCBS MAPPO |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$34.03
|
| Rate for Payer: BCBS Trust/PPO |
$40.01
|
| Rate for Payer: BCN Commercial |
$40.01
|
| Rate for Payer: BCN Commercial |
$34.03
|
| Rate for Payer: BCN Medicare Advantage |
$12.17
|
| Rate for Payer: BCN Medicare Advantage |
$10.35
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.35
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Commercial |
$43.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.50
|
| Rate for Payer: Mclaren Medicaid |
$8.58
|
| Rate for Payer: Mclaren Medicaid |
$7.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.86
|
| Rate for Payer: Meridian Medicaid |
$7.66
|
| Rate for Payer: Meridian Medicaid |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Nomi Health Commercial |
$39.91
|
| Rate for Payer: Nomi Health Commercial |
$33.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.83
|
| Rate for Payer: PACE SWMI |
$12.17
|
| Rate for Payer: PACE SWMI |
$10.35
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$41.37
|
| Rate for Payer: PHP Medicare Advantage |
$10.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.01
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Medicare |
$10.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.83
|
| Rate for Payer: UHC Core |
$40.64
|
| Rate for Payer: UHC Core |
$34.56
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicaid |
$8.58
|
| Rate for Payer: UHC Medicaid |
$7.30
|
| Rate for Payer: UHC Medicare Advantage |
$10.35
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: UHCCP Medicaid |
$7.30
|
| Rate for Payer: UHCCP Medicaid |
$8.58
|
| Rate for Payer: VA VA |
$10.35
|
| Rate for Payer: VA VA |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS J3375
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$79.76
|
| Rate for Payer: BCN Commercial |
$79.76
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Nomi Health Commercial |
$79.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.98
|
| Rate for Payer: UHC Core |
$80.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.43
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$96.57
|
|
|
Service Code
|
HCPCS J3375
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.18
|
| Rate for Payer: BCBS Complete |
$17.88
|
| Rate for Payer: BCBS MAPPO |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.39
|
| Rate for Payer: BCN Commercial |
$79.39
|
| Rate for Payer: BCN Medicare Advantage |
$24.14
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.43
|
| Rate for Payer: Mclaren Medicaid |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Nomi Health Commercial |
$79.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: PACE Senior Care Partners |
$22.94
|
| Rate for Payer: PACE SWMI |
$24.14
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: PHP Medicare Advantage |
$24.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.02
|
| Rate for Payer: Priority Health Medicare |
$24.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.21
|
| Rate for Payer: Railroad Medicare Medicare |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.98
|
| Rate for Payer: UHC Core |
$80.64
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UHC Medicaid |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$24.14
|
| Rate for Payer: UHCCP Medicaid |
$17.03
|
| Rate for Payer: VA VA |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.43
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.33
|
| Rate for Payer: BCN Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.93
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$18.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Mclaren Medicaid |
$3.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.82
|
| Rate for Payer: Meridian Medicaid |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: PACE Senior Care Partners |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.55
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicaid |
$3.91
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: UHCCP Medicaid |
$3.91
|
| Rate for Payer: VA VA |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.47
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS MAPPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$69.63
|
| Rate for Payer: BCN Commercial |
$69.63
|
| Rate for Payer: BCN Medicare Advantage |
$21.18
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.23
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.52
|
| Rate for Payer: PACE Senior Care Partners |
$20.12
|
| Rate for Payer: PACE SWMI |
$21.18
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: PHP Medicare Advantage |
$21.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.95
|
| Rate for Payer: Railroad Medicare Medicare |
$21.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UHC Medicaid |
$14.93
|
| Rate for Payer: UHC Medicare Advantage |
$21.18
|
| Rate for Payer: UHCCP Medicaid |
$14.93
|
| Rate for Payer: VA VA |
$21.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.95
|
| Rate for Payer: BCN Commercial |
$69.95
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.52
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$110.36
|
|
|
Service Code
|
HCPCS J3375
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: Aetna Medicare |
$28.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.49
|
| Rate for Payer: BCBS Complete |
$20.43
|
| Rate for Payer: BCBS MAPPO |
$27.59
|
| Rate for Payer: BCBS Trust/PPO |
$90.73
|
| Rate for Payer: BCN Commercial |
$90.73
|
| Rate for Payer: BCN Medicare Advantage |
$27.59
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.59
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.77
|
| Rate for Payer: Mclaren Medicaid |
$19.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.97
|
| Rate for Payer: Meridian Medicaid |
$20.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: Nomi Health Commercial |
$90.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.77
|
| Rate for Payer: PACE Senior Care Partners |
$26.21
|
| Rate for Payer: PACE SWMI |
$27.59
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: PHP Medicare Advantage |
$27.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.01
|
| Rate for Payer: Priority Health Medicare |
$27.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.81
|
| Rate for Payer: Railroad Medicare Medicare |
$27.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.12
|
| Rate for Payer: UHC Core |
$92.15
|
| Rate for Payer: UHC Exchange |
$27.59
|
| Rate for Payer: UHC Medicaid |
$19.46
|
| Rate for Payer: UHC Medicare Advantage |
$27.59
|
| Rate for Payer: UHCCP Medicaid |
$19.46
|
| Rate for Payer: VA VA |
$27.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.77
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$110.36
|
|
|
Service Code
|
HCPCS J3375
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.81 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: BCBS Trust/PPO |
$91.15
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: Nomi Health Commercial |
$90.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.77
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.12
|
| Rate for Payer: UHC Core |
$92.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.77
|
|
|
VANCOMYCIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.33
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
207946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.03 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna Commercial |
$149.03
|
| Rate for Payer: BCBS Trust/PPO |
$144.81
|
| Rate for Payer: BCN Commercial |
$144.81
|
| Rate for Payer: Cash Price |
$140.26
|
| Rate for Payer: Cofinity Commercial |
$150.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.26
|
| Rate for Payer: Healthscope Commercial |
$157.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.03
|
| Rate for Payer: Nomi Health Commercial |
$143.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.50
|
| Rate for Payer: PHP Commercial |
$149.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.29
|
| Rate for Payer: UHC Core |
$146.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.50
|
|
|
VANCOMYCIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175.33
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
207946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna Commercial |
$149.03
|
| Rate for Payer: Aetna Medicare |
$45.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.79
|
| Rate for Payer: BCBS Complete |
$32.45
|
| Rate for Payer: BCBS MAPPO |
$43.83
|
| Rate for Payer: BCBS Trust/PPO |
$144.14
|
| Rate for Payer: BCN Commercial |
$144.14
|
| Rate for Payer: BCN Medicare Advantage |
$43.83
|
| Rate for Payer: Cash Price |
$140.26
|
| Rate for Payer: Cofinity Commercial |
$150.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.83
|
| Rate for Payer: Healthscope Commercial |
$157.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.50
|
| Rate for Payer: Mclaren Medicaid |
$30.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.02
|
| Rate for Payer: Meridian Medicaid |
$32.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.03
|
| Rate for Payer: Nomi Health Commercial |
$143.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.50
|
| Rate for Payer: PACE Senior Care Partners |
$41.64
|
| Rate for Payer: PACE SWMI |
$43.83
|
| Rate for Payer: PHP Commercial |
$149.03
|
| Rate for Payer: PHP Medicare Advantage |
$43.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.54
|
| Rate for Payer: Priority Health Medicare |
$44.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.03
|
| Rate for Payer: Railroad Medicare Medicare |
$43.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.29
|
| Rate for Payer: UHC Core |
$146.40
|
| Rate for Payer: UHC Exchange |
$43.83
|
| Rate for Payer: UHC Medicaid |
$30.91
|
| Rate for Payer: UHC Medicare Advantage |
$43.83
|
| Rate for Payer: UHCCP Medicaid |
$30.91
|
| Rate for Payer: VA VA |
$43.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.50
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.84
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS MAPPO |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.67
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.67
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: Meridian Medicaid |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: PACE Senior Care Partners |
$4.44
|
| Rate for Payer: PACE SWMI |
$4.67
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Medicare Advantage |
$4.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Medicare |
$4.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Exchange |
$4.67
|
| Rate for Payer: UHC Medicaid |
$3.30
|
| Rate for Payer: UHC Medicare Advantage |
$4.67
|
| Rate for Payer: UHCCP Medicaid |
$3.30
|
| Rate for Payer: VA VA |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.24
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Commercial |
$21.67
|
| Rate for Payer: BCN Commercial |
$13.36
|
| Rate for Payer: BCN Commercial |
$23.95
|
| Rate for Payer: BCN Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$22.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.09
|
| Rate for Payer: UHC Core |
$21.91
|
| Rate for Payer: UHC Core |
$24.21
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.68
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$4.67
|
| Rate for Payer: BCBS MAPPO |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$6.56
|
| Rate for Payer: BCBS Trust/PPO |
$21.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$21.57
|
| Rate for Payer: BCN Commercial |
$23.84
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: BCN Medicare Advantage |
$6.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.67
|
| Rate for Payer: BCN Medicare Advantage |
$7.25
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.56
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Mclaren Medicaid |
$4.63
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: Meridian Medicaid |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Meridian Medicaid |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Nomi Health Commercial |
$21.52
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: PACE Senior Care Partners |
$6.23
|
| Rate for Payer: PACE Senior Care Partners |
$6.89
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.44
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$7.25
|
| Rate for Payer: PACE SWMI |
$4.67
|
| Rate for Payer: PACE SWMI |
$6.56
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$22.30
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.08
|
| Rate for Payer: Priority Health Medicare |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Medicare |
$7.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.56
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Core |
$21.91
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Core |
$24.21
|
| Rate for Payer: UHC Exchange |
$6.56
|
| Rate for Payer: UHC Exchange |
$4.67
|
| Rate for Payer: UHC Exchange |
$7.25
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Medicaid |
$2.85
|
| Rate for Payer: UHC Medicaid |
$3.30
|
| Rate for Payer: UHC Medicaid |
$4.63
|
| Rate for Payer: UHC Medicaid |
$5.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.67
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$7.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.56
|
| Rate for Payer: UHCCP Medicaid |
$4.63
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$3.30
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$7.25
|
| Rate for Payer: VA VA |
$6.56
|
| Rate for Payer: VA VA |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
|
|
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 |
$620.39 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: BCBS Trust/PPO |
$736.17
|
| Rate for Payer: BCN Commercial |
$736.17
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: Nomi Health Commercial |
$730.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$668.52
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$775.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$620.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$784.40
|
| Rate for Payer: UHC Core |
$744.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
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 |
$157.15 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$231.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$278.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$278.55
|
| Rate for Payer: BCBS Complete |
$164.99
|
| Rate for Payer: BCBS MAPPO |
$222.84
|
| Rate for Payer: BCBS Trust/PPO |
$732.79
|
| Rate for Payer: BCN Commercial |
$732.79
|
| Rate for Payer: BCN Medicare Advantage |
$222.84
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.84
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: Mclaren Medicaid |
$157.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.98
|
| Rate for Payer: Meridian Medicaid |
$164.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: Nomi Health Commercial |
$730.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$668.52
|
| Rate for Payer: PACE Senior Care Partners |
$211.70
|
| Rate for Payer: PACE SWMI |
$222.84
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: PHP Medicare Advantage |
$222.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$775.48
|
| Rate for Payer: Priority Health Medicare |
$225.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$620.39
|
| Rate for Payer: Railroad Medicare Medicare |
$222.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$784.40
|
| Rate for Payer: UHC Core |
$744.29
|
| Rate for Payer: UHC Exchange |
$222.84
|
| Rate for Payer: UHC Medicaid |
$157.15
|
| Rate for Payer: UHC Medicare Advantage |
$222.84
|
| Rate for Payer: UHCCP Medicaid |
$157.15
|
| Rate for Payer: VA VA |
$222.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
