|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$290.88
|
|
|
Service Code
|
NDC 50268074815
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$261.79 |
| Rate for Payer: Aetna Commercial |
$247.25
|
| Rate for Payer: Aetna Medicare |
$75.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.90
|
| Rate for Payer: BCBS Complete |
$116.35
|
| Rate for Payer: BCBS MAPPO |
$72.72
|
| Rate for Payer: BCBS Trust/PPO |
$239.13
|
| Rate for Payer: BCN Commercial |
$226.16
|
| Rate for Payer: BCN Medicare Advantage |
$72.72
|
| Rate for Payer: Cash Price |
$232.70
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.72
|
| Rate for Payer: Healthscope Commercial |
$261.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.25
|
| Rate for Payer: Nomi Health Commercial |
$238.52
|
| Rate for Payer: PACE Senior Care Partners |
$69.08
|
| Rate for Payer: PACE SWMI |
$72.72
|
| Rate for Payer: PHP Commercial |
$247.25
|
| Rate for Payer: PHP Medicare Advantage |
$72.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.07
|
| Rate for Payer: Priority Health HMO/PPO |
$253.07
|
| Rate for Payer: Priority Health Medicare |
$73.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.89
|
| Rate for Payer: Railroad Medicare Medicare |
$72.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.97
|
| Rate for Payer: UHC Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.72
|
| Rate for Payer: UHC Exchange |
$72.72
|
| Rate for Payer: UHC Medicare Advantage |
$72.72
|
| Rate for Payer: VA VA |
$72.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.16
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$233.42
|
|
|
Service Code
|
NDC 65862057290
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Aetna Commercial |
$198.41
|
| Rate for Payer: Aetna Medicare |
$60.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.94
|
| Rate for Payer: BCBS Complete |
$93.37
|
| Rate for Payer: BCBS MAPPO |
$58.36
|
| Rate for Payer: BCBS Trust/PPO |
$191.89
|
| Rate for Payer: BCN Commercial |
$181.48
|
| Rate for Payer: BCN Medicare Advantage |
$58.36
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Commercial |
$200.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.36
|
| Rate for Payer: Healthscope Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.41
|
| Rate for Payer: Nomi Health Commercial |
$191.40
|
| Rate for Payer: PACE Senior Care Partners |
$55.44
|
| Rate for Payer: PACE SWMI |
$58.36
|
| Rate for Payer: PHP Commercial |
$198.41
|
| Rate for Payer: PHP Medicare Advantage |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.72
|
| Rate for Payer: Priority Health HMO/PPO |
$203.08
|
| Rate for Payer: Priority Health Medicare |
$58.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.39
|
| Rate for Payer: Railroad Medicare Medicare |
$58.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.41
|
| Rate for Payer: UHC Core |
$194.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.36
|
| Rate for Payer: UHC Exchange |
$58.36
|
| Rate for Payer: UHC Medicare Advantage |
$58.36
|
| Rate for Payer: VA VA |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
NDC 50268074811
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$4.75
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO |
$5.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$290.88
|
|
|
Service Code
|
NDC 50268074815
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$261.79 |
| Rate for Payer: Aetna Commercial |
$247.25
|
| Rate for Payer: BCBS Trust/PPO |
$237.45
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: Cash Price |
$232.70
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.70
|
| Rate for Payer: Healthscope Commercial |
$261.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.25
|
| Rate for Payer: Nomi Health Commercial |
$238.52
|
| Rate for Payer: PHP Commercial |
$247.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.07
|
| Rate for Payer: Priority Health HMO/PPO |
$253.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.97
|
| Rate for Payer: UHC Core |
$242.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.16
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$3,078.59
|
|
|
Service Code
|
NDC 00078035934
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$731.17 |
| Max. Negotiated Rate |
$2,770.73 |
| Rate for Payer: Aetna Commercial |
$2,616.80
|
| Rate for Payer: Aetna Medicare |
$800.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$962.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$962.06
|
| Rate for Payer: BCBS Complete |
$1,231.44
|
| Rate for Payer: BCBS MAPPO |
$769.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,530.91
|
| Rate for Payer: BCN Commercial |
$2,393.60
|
| Rate for Payer: BCN Medicare Advantage |
$769.65
|
| Rate for Payer: Cash Price |
$2,462.87
|
| Rate for Payer: Cofinity Commercial |
$2,647.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,462.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.65
|
| Rate for Payer: Healthscope Commercial |
$2,770.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,308.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$808.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$885.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,616.80
|
| Rate for Payer: Nomi Health Commercial |
$2,524.44
|
| Rate for Payer: PACE Senior Care Partners |
$731.17
|
| Rate for Payer: PACE SWMI |
$769.65
|
| Rate for Payer: PHP Commercial |
$2,616.80
|
| Rate for Payer: PHP Medicare Advantage |
$769.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,001.08
|
| Rate for Payer: Priority Health HMO/PPO |
$2,678.37
|
| Rate for Payer: Priority Health Medicare |
$777.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,062.66
|
| Rate for Payer: Railroad Medicare Medicare |
$769.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,709.16
|
| Rate for Payer: UHC Core |
$2,570.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$769.65
|
| Rate for Payer: UHC Exchange |
$769.65
|
| Rate for Payer: UHC Medicare Advantage |
$769.65
|
| Rate for Payer: VA VA |
$769.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,308.94
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$538.08
|
|
|
Service Code
|
NDC 60687063401
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$484.27 |
| Rate for Payer: Aetna Commercial |
$457.37
|
| Rate for Payer: BCBS Trust/PPO |
$439.23
|
| Rate for Payer: BCN Commercial |
$415.83
|
| Rate for Payer: Cash Price |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$462.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.46
|
| Rate for Payer: Healthscope Commercial |
$484.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.37
|
| Rate for Payer: Nomi Health Commercial |
$441.23
|
| Rate for Payer: PHP Commercial |
$457.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.75
|
| Rate for Payer: Priority Health HMO/PPO |
$468.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.51
|
| Rate for Payer: UHC Core |
$449.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.56
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$5.39
|
|
|
Service Code
|
NDC 60687063411
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$4.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.58
|
| Rate for Payer: Nomi Health Commercial |
$4.42
|
| Rate for Payer: PHP Commercial |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 60687061211
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$70.68
|
|
|
Service Code
|
NDC 00378580793
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Aetna Medicare |
$18.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.09
|
| Rate for Payer: BCBS Complete |
$28.27
|
| Rate for Payer: BCBS MAPPO |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$54.95
|
| Rate for Payer: BCN Medicare Advantage |
$17.67
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.67
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: PACE Senior Care Partners |
$16.79
|
| Rate for Payer: PACE SWMI |
$17.67
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: PHP Medicare Advantage |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.94
|
| Rate for Payer: Priority Health HMO/PPO |
$61.49
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.36
|
| Rate for Payer: Railroad Medicare Medicare |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$59.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.67
|
| Rate for Payer: UHC Exchange |
$17.67
|
| Rate for Payer: UHC Medicare Advantage |
$17.67
|
| Rate for Payer: VA VA |
$17.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$111.46
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Medicare |
$28.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: BCBS Complete |
$44.58
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCBS Trust/PPO |
$91.63
|
| Rate for Payer: BCN Commercial |
$86.66
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: Cofinity Commercial |
$95.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Healthscope Commercial |
$100.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.74
|
| Rate for Payer: Nomi Health Commercial |
$91.40
|
| Rate for Payer: PACE Senior Care Partners |
$26.47
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PHP Commercial |
$94.74
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health HMO/PPO |
$96.97
|
| Rate for Payer: Priority Health Medicare |
$28.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.68
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.08
|
| Rate for Payer: UHC Core |
$93.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Exchange |
$27.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: VA VA |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.60
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$111.46
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: BCBS Trust/PPO |
$90.98
|
| Rate for Payer: BCN Commercial |
$86.14
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: Cofinity Commercial |
$95.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.17
|
| Rate for Payer: Healthscope Commercial |
$100.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.74
|
| Rate for Payer: Nomi Health Commercial |
$91.40
|
| Rate for Payer: PHP Commercial |
$94.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health HMO/PPO |
$96.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.08
|
| Rate for Payer: UHC Core |
$93.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.60
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$798.32
|
|
|
Service Code
|
NDC 00078042315
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.91 |
| Max. Negotiated Rate |
$718.49 |
| Rate for Payer: Aetna Commercial |
$678.57
|
| Rate for Payer: BCBS Trust/PPO |
$651.67
|
| Rate for Payer: BCN Commercial |
$616.94
|
| Rate for Payer: Cash Price |
$638.66
|
| Rate for Payer: Cofinity Commercial |
$686.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.66
|
| Rate for Payer: Healthscope Commercial |
$718.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$598.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.57
|
| Rate for Payer: Nomi Health Commercial |
$654.62
|
| Rate for Payer: PHP Commercial |
$678.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.91
|
| Rate for Payer: Priority Health HMO/PPO |
$694.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$534.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.52
|
| Rate for Payer: UHC Core |
$666.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.74
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$798.32
|
|
|
Service Code
|
NDC 00078042315
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$718.49 |
| Rate for Payer: Aetna Commercial |
$678.57
|
| Rate for Payer: Aetna Medicare |
$207.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.48
|
| Rate for Payer: BCBS Complete |
$319.33
|
| Rate for Payer: BCBS MAPPO |
$199.58
|
| Rate for Payer: BCBS Trust/PPO |
$656.30
|
| Rate for Payer: BCN Commercial |
$620.69
|
| Rate for Payer: BCN Medicare Advantage |
$199.58
|
| Rate for Payer: Cash Price |
$638.66
|
| Rate for Payer: Cofinity Commercial |
$686.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.58
|
| Rate for Payer: Healthscope Commercial |
$718.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$598.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.57
|
| Rate for Payer: Nomi Health Commercial |
$654.62
|
| Rate for Payer: PACE Senior Care Partners |
$189.60
|
| Rate for Payer: PACE SWMI |
$199.58
|
| Rate for Payer: PHP Commercial |
$678.57
|
| Rate for Payer: PHP Medicare Advantage |
$199.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.91
|
| Rate for Payer: Priority Health HMO/PPO |
$694.54
|
| Rate for Payer: Priority Health Medicare |
$201.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$534.87
|
| Rate for Payer: Railroad Medicare Medicare |
$199.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.52
|
| Rate for Payer: UHC Core |
$666.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.58
|
| Rate for Payer: UHC Exchange |
$199.58
|
| Rate for Payer: UHC Medicare Advantage |
$199.58
|
| Rate for Payer: VA VA |
$199.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.74
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$70.68
|
|
|
Service Code
|
NDC 00378580793
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: BCBS Trust/PPO |
$57.70
|
| Rate for Payer: BCN Commercial |
$54.62
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.94
|
| Rate for Payer: Priority Health HMO/PPO |
$61.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 60687061211
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
IP
|
$23.63
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCBS Trust/PPO |
$12.54
|
| Rate for Payer: BCBS Trust/PPO |
$25.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$13.46
|
| Rate for Payer: BCN Commercial |
$11.87
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Commercial |
$23.99
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: BCN Commercial |
$18.87
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$20.32
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$21.27
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Nomi Health Commercial |
$15.20
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: Nomi Health Commercial |
$25.45
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: Nomi Health Commercial |
$14.28
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$16.13
|
| Rate for Payer: Priority Health HMO/PPO |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO |
$13.36
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health HMO/PPO |
$21.25
|
| Rate for Payer: Priority Health HMO/PPO |
$15.16
|
| Rate for Payer: Priority Health HMO/PPO |
$27.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$19.73
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$15.48
|
| Rate for Payer: UHC Core |
$25.92
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.90
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
OP
|
$15.36
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Medicare |
$6.14
|
| Rate for Payer: Aetna Medicare |
$4.82
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS Complete |
$6.14
|
| Rate for Payer: BCBS Complete |
$9.45
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS MAPPO |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCBS MAPPO |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$4.41
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCBS Trust/PPO |
$15.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$20.08
|
| Rate for Payer: BCN Commercial |
$24.13
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Commercial |
$18.37
|
| Rate for Payer: BCN Commercial |
$14.41
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: BCN Commercial |
$11.94
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.64
|
| Rate for Payer: BCN Medicare Advantage |
$6.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: BCN Medicare Advantage |
$5.91
|
| Rate for Payer: BCN Medicare Advantage |
$4.41
|
| Rate for Payer: BCN Medicare Advantage |
$4.16
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$20.32
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$21.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: Nomi Health Commercial |
$14.28
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Nomi Health Commercial |
$25.45
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$15.20
|
| Rate for Payer: PACE Senior Care Partners |
$7.37
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.19
|
| Rate for Payer: PACE Senior Care Partners |
$5.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.80
|
| Rate for Payer: PACE Senior Care Partners |
$4.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.95
|
| Rate for Payer: PACE SWMI |
$4.64
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PACE SWMI |
$4.41
|
| Rate for Payer: PACE SWMI |
$4.16
|
| Rate for Payer: PACE SWMI |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.10
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$14.81
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Medicare Advantage |
$6.10
|
| Rate for Payer: PHP Medicare Advantage |
$4.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.16
|
| Rate for Payer: PHP Medicare Advantage |
$4.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$27.00
|
| Rate for Payer: Priority Health HMO/PPO |
$16.13
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health HMO/PPO |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$13.36
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health HMO/PPO |
$21.25
|
| Rate for Payer: Priority Health HMO/PPO |
$15.16
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Medicare |
$4.68
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$5.97
|
| Rate for Payer: Priority Health Medicare |
$6.17
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.32
|
| Rate for Payer: UHC Core |
$15.48
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Core |
$19.73
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: UHC Core |
$25.92
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.64
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Exchange |
$6.10
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.91
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
| Rate for Payer: UHC Medicare Advantage |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: VA VA |
$6.10
|
| Rate for Payer: VA VA |
$4.64
|
| Rate for Payer: VA VA |
$4.16
|
| Rate for Payer: VA VA |
$4.41
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: VA VA |
$5.91
|
| Rate for Payer: VA VA |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.52
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: BCBS Trust/PPO |
$56.31
|
| Rate for Payer: BCN Commercial |
$53.31
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health HMO/PPO |
$60.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.70
|
| Rate for Payer: UHC Core |
$57.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.74
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$17.24
|
| Rate for Payer: BCBS Trust/PPO |
$56.71
|
| Rate for Payer: BCN Commercial |
$53.63
|
| Rate for Payer: BCN Medicare Advantage |
$17.24
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: PACE Senior Care Partners |
$16.38
|
| Rate for Payer: PACE SWMI |
$17.24
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: PHP Medicare Advantage |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health HMO/PPO |
$60.01
|
| Rate for Payer: Priority Health Medicare |
$17.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.70
|
| Rate for Payer: UHC Core |
$57.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.24
|
| Rate for Payer: UHC Exchange |
$17.24
|
| Rate for Payer: UHC Medicare Advantage |
$17.24
|
| Rate for Payer: VA VA |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.74
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
NDC 23155085878
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.07 |
| 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 |
$48.96
|
| Rate for Payer: BCBS MAPPO |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$100.63
|
| Rate for Payer: BCN Commercial |
$95.17
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.04
|
| Rate for Payer: Nomi Health Commercial |
$100.37
|
| 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 Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health HMO/PPO |
$106.49
|
| Rate for Payer: Priority Health Medicare |
$30.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.01
|
| 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 Dual Complete DSNP |
$30.60
|
| Rate for Payer: UHC Exchange |
$30.60
|
| Rate for Payer: UHC Medicare Advantage |
$30.60
|
| Rate for Payer: VA VA |
$30.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.80
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
NDC 23155085878
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$99.92
|
| Rate for Payer: BCN Commercial |
$94.59
|
| 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: PHP Commercial |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health HMO/PPO |
$106.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.01
|
| 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
|
IP
|
$120.20
|
|
|
Service Code
|
NDC 00121086720
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$108.18 |
| Rate for Payer: Aetna Commercial |
$102.17
|
| Rate for Payer: BCBS Trust/PPO |
$98.12
|
| Rate for Payer: BCN Commercial |
$92.89
|
| 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: Healthscope Commercial |
$108.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.17
|
| Rate for Payer: Nomi Health Commercial |
$98.56
|
| Rate for Payer: PHP Commercial |
$102.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.13
|
| Rate for Payer: Priority Health HMO/PPO |
$104.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.78
|
| Rate for Payer: UHC Core |
$100.37
|
| 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 |
$111.83 |
| Max. Negotiated Rate |
$154.84 |
| Rate for Payer: Aetna Commercial |
$146.24
|
| Rate for Payer: BCBS Trust/PPO |
$140.44
|
| Rate for Payer: BCN Commercial |
$132.96
|
| 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: PHP Commercial |
$146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.83
|
| Rate for Payer: Priority Health HMO/PPO |
$149.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.27
|
| 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
|
$120.20
|
|
|
Service Code
|
NDC 00121086720
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.55 |
| 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 |
$48.08
|
| Rate for Payer: BCBS MAPPO |
$30.05
|
| Rate for Payer: BCBS Trust/PPO |
$98.82
|
| Rate for Payer: BCN Commercial |
$93.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.17
|
| Rate for Payer: Nomi Health Commercial |
$98.56
|
| 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 Cigna Priority Health |
$78.13
|
| Rate for Payer: Priority Health HMO/PPO |
$104.57
|
| Rate for Payer: Priority Health Medicare |
$30.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.53
|
| 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 Dual Complete DSNP |
$30.05
|
| Rate for Payer: UHC Exchange |
$30.05
|
| Rate for Payer: UHC Medicare Advantage |
$30.05
|
| Rate for Payer: VA VA |
$30.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.15
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$172.05
|
|
|
Service Code
|
NDC 62559039020
|
| Hospital Charge Code |
11628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.86 |
| 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 |
$68.82
|
| Rate for Payer: BCBS MAPPO |
$43.01
|
| Rate for Payer: BCBS Trust/PPO |
$141.44
|
| Rate for Payer: BCN Commercial |
$133.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.24
|
| Rate for Payer: Nomi Health Commercial |
$141.08
|
| 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 Cigna Priority Health |
$111.83
|
| Rate for Payer: Priority Health HMO/PPO |
$149.68
|
| Rate for Payer: Priority Health Medicare |
$43.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.27
|
| 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 Dual Complete DSNP |
$43.01
|
| Rate for Payer: UHC Exchange |
$43.01
|
| Rate for Payer: UHC Medicare Advantage |
$43.01
|
| Rate for Payer: VA VA |
$43.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.04
|
|
