|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: BCBS Trust/PPO |
$67.57
|
| Rate for Payer: BCN Commercial |
$63.96
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health HMO/PPO |
$72.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
| Rate for Payer: UHC Core |
$69.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$21.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.87
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS MAPPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$68.05
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.69
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: PACE Senior Care Partners |
$19.66
|
| Rate for Payer: PACE SWMI |
$20.69
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health HMO/PPO |
$72.01
|
| Rate for Payer: Priority Health Medicare |
$20.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.46
|
| Rate for Payer: Railroad Medicare Medicare |
$20.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
| Rate for Payer: UHC Core |
$69.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.69
|
| Rate for Payer: UHC Exchange |
$20.69
|
| Rate for Payer: UHC Medicare Advantage |
$20.69
|
| Rate for Payer: VA VA |
$20.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$51.37
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| 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 |
$20.55
|
| Rate for Payer: BCBS MAPPO |
$12.84
|
| Rate for Payer: BCBS Trust/PPO |
$42.23
|
| Rate for Payer: BCN Commercial |
$39.94
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| 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 Cigna Priority Health |
$33.39
|
| Rate for Payer: Priority Health HMO/PPO |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.42
|
| 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 Dual Complete DSNP |
$12.84
|
| Rate for Payer: UHC Exchange |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$12.84
|
| 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
|
$51.37
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
189183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$46.23 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$39.70
|
| 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: PHP Commercial |
$43.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.39
|
| Rate for Payer: Priority Health HMO/PPO |
$44.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.42
|
| 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 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.77 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$78.83
|
| Rate for Payer: BCN Commercial |
$74.63
|
| 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: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health HMO/PPO |
$84.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.70
|
| 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 J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.94 |
| 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 |
$38.63
|
| Rate for Payer: BCBS MAPPO |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.39
|
| Rate for Payer: BCN Commercial |
$75.08
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Nomi Health Commercial |
$79.19
|
| 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 Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health HMO/PPO |
$84.02
|
| Rate for Payer: Priority Health Medicare |
$24.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.70
|
| 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 Dual Complete DSNP |
$24.14
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UHC Medicare Advantage |
$24.14
|
| Rate for Payer: VA VA |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.43
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$55.18
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna Medicare |
$14.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.24
|
| Rate for Payer: BCBS Complete |
$22.07
|
| Rate for Payer: BCBS MAPPO |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$45.36
|
| Rate for Payer: BCN Commercial |
$42.90
|
| Rate for Payer: BCN Medicare Advantage |
$13.80
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: PACE Senior Care Partners |
$13.11
|
| Rate for Payer: PACE SWMI |
$13.80
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.87
|
| Rate for Payer: Priority Health HMO/PPO |
$48.01
|
| Rate for Payer: Priority Health Medicare |
$13.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.56
|
| Rate for Payer: UHC Core |
$46.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.80
|
| Rate for Payer: UHC Exchange |
$13.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.80
|
| Rate for Payer: VA VA |
$13.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.38
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$55.18
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: BCBS Trust/PPO |
$45.04
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.87
|
| Rate for Payer: Priority Health HMO/PPO |
$48.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.56
|
| Rate for Payer: UHC Core |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.38
|
|
|
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 |
$20.12 |
| 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 |
$33.88
|
| Rate for Payer: BCBS MAPPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$69.63
|
| Rate for Payer: BCN Commercial |
$65.85
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| 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 Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| 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 Dual Complete DSNP |
$21.18
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UHC Medicare Advantage |
$21.18
|
| 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 |
$55.06 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.14
|
| Rate for Payer: BCN Commercial |
$65.46
|
| 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: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| 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
|
IP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.73 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: BCBS Trust/PPO |
$90.09
|
| Rate for Payer: BCN Commercial |
$85.29
|
| 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: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health HMO/PPO |
$96.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.94
|
| 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/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| 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 |
$44.14
|
| Rate for Payer: BCBS MAPPO |
$27.59
|
| Rate for Payer: BCBS Trust/PPO |
$90.73
|
| Rate for Payer: BCN Commercial |
$85.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: Nomi Health Commercial |
$90.50
|
| 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 Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health HMO/PPO |
$96.01
|
| Rate for Payer: Priority Health Medicare |
$27.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.94
|
| 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 Dual Complete DSNP |
$27.59
|
| Rate for Payer: UHC Exchange |
$27.59
|
| Rate for Payer: UHC Medicare Advantage |
$27.59
|
| Rate for Payer: VA VA |
$27.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.77
|
|
|
VANCOMYCIN 500 MG/100 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$27.59
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
191707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.52
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.45
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PHP Commercial |
$23.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.93
|
| Rate for Payer: Priority Health HMO/PPO |
$24.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.28
|
| Rate for Payer: UHC Core |
$23.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.69
|
|
|
VANCOMYCIN 500 MG/100 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$27.59
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
191707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.62
|
| Rate for Payer: BCBS Complete |
$11.04
|
| Rate for Payer: BCBS MAPPO |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$22.68
|
| Rate for Payer: BCN Commercial |
$21.45
|
| Rate for Payer: BCN Medicare Advantage |
$6.90
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.45
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PACE Senior Care Partners |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.90
|
| Rate for Payer: PHP Commercial |
$23.45
|
| Rate for Payer: PHP Medicare Advantage |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.93
|
| Rate for Payer: Priority Health HMO/PPO |
$24.00
|
| Rate for Payer: Priority Health Medicare |
$6.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.49
|
| Rate for Payer: Railroad Medicare Medicare |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.28
|
| Rate for Payer: UHC Core |
$23.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.90
|
| Rate for Payer: UHC Exchange |
$6.90
|
| Rate for Payer: UHC Medicare Advantage |
$6.90
|
| Rate for Payer: VA VA |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.69
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: PACE Senior Care Partners |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.54
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCBS Trust/PPO |
$23.67
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| 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 |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health HMO/PPO |
$14.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Core |
$24.22
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.06
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCBS Trust/PPO |
$23.84
|
| Rate for Payer: BCN Commercial |
$20.34
|
| Rate for Payer: BCN Commercial |
$22.55
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$7.25
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.75
|
| Rate for Payer: Nomi Health Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| 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 |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PACE SWMI |
$7.25
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$13.75
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health HMO/PPO |
$25.23
|
| Rate for Payer: Priority Health HMO/PPO |
$14.08
|
| Rate for Payer: Priority Health HMO/PPO |
$22.76
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Medicare |
$7.32
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$7.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
| Rate for Payer: UHC Core |
$24.22
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.54
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Exchange |
$7.25
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$7.25
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$7.25
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
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 |
$211.70 |
| 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 |
$356.54
|
| Rate for Payer: BCBS MAPPO |
$222.84
|
| Rate for Payer: BCBS Trust/PPO |
$732.79
|
| Rate for Payer: BCN Commercial |
$693.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: Nomi Health Commercial |
$730.92
|
| 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 Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health HMO/PPO |
$775.48
|
| Rate for Payer: Priority Health Medicare |
$225.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$597.21
|
| 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 Dual Complete DSNP |
$222.84
|
| Rate for Payer: UHC Exchange |
$222.84
|
| Rate for Payer: UHC Medicare Advantage |
$222.84
|
| Rate for Payer: VA VA |
$222.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
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 |
$579.38 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: BCBS Trust/PPO |
$727.62
|
| Rate for Payer: BCN Commercial |
$688.84
|
| 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: 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: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health HMO/PPO |
$775.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$597.21
|
| 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 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: BCBS Trust/PPO |
$33.79
|
| Rate for Payer: BCN Commercial |
$31.99
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Nomi Health Commercial |
$33.94
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health HMO/PPO |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC Core |
$34.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.93
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: BCBS MAPPO |
$10.35
|
| Rate for Payer: BCBS Trust/PPO |
$34.03
|
| Rate for Payer: BCN Commercial |
$32.18
|
| Rate for Payer: BCN Medicare Advantage |
$10.35
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.35
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: Nomi Health Commercial |
$33.94
|
| Rate for Payer: PACE Senior Care Partners |
$9.83
|
| Rate for Payer: PACE SWMI |
$10.35
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: PHP Medicare Advantage |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health HMO/PPO |
$36.01
|
| Rate for Payer: Priority Health Medicare |
$10.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.73
|
| Rate for Payer: Railroad Medicare Medicare |
$10.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC Core |
$34.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.35
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicare Advantage |
$10.35
|
| Rate for Payer: VA VA |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.10
|
|
|
Service Code
|
HCPCS J3371
|
| Hospital Charge Code |
97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.73
|
| Rate for Payer: BCN Commercial |
$30.99
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Cofinity Commercial |
$34.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.08
|
| Rate for Payer: Healthscope Commercial |
$36.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.08
|
| Rate for Payer: Nomi Health Commercial |
$32.88
|
| Rate for Payer: PHP Commercial |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.06
|
| Rate for Payer: Priority Health HMO/PPO |
$34.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.29
|
| Rate for Payer: UHC Core |
$33.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.10
|
|
|
Service Code
|
HCPCS J3371
|
| Hospital Charge Code |
97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.53
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$10.02
|
| Rate for Payer: BCBS Trust/PPO |
$32.97
|
| Rate for Payer: BCN Commercial |
$31.18
|
| Rate for Payer: BCN Medicare Advantage |
$10.02
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Cofinity Commercial |
$34.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.02
|
| Rate for Payer: Healthscope Commercial |
$36.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.08
|
| Rate for Payer: Nomi Health Commercial |
$32.88
|
| Rate for Payer: PACE Senior Care Partners |
$9.52
|
| Rate for Payer: PACE SWMI |
$10.02
|
| Rate for Payer: PHP Commercial |
$34.08
|
| Rate for Payer: PHP Medicare Advantage |
$10.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.06
|
| Rate for Payer: Priority Health HMO/PPO |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$10.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.29
|
| Rate for Payer: UHC Core |
$33.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.02
|
| Rate for Payer: UHC Exchange |
$10.02
|
| Rate for Payer: UHC Medicare Advantage |
$10.02
|
| Rate for Payer: VA VA |
$10.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$250.53
|
|
|
Service Code
|
NDC 49884015676
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$225.48 |
| Rate for Payer: Aetna Commercial |
$212.95
|
| Rate for Payer: BCBS Trust/PPO |
$204.51
|
| Rate for Payer: BCN Commercial |
$193.61
|
| Rate for Payer: Cash Price |
$200.42
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.42
|
| Rate for Payer: Healthscope Commercial |
$225.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.95
|
| Rate for Payer: Nomi Health Commercial |
$205.43
|
| Rate for Payer: PHP Commercial |
$212.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.84
|
| Rate for Payer: Priority Health HMO/PPO |
$217.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.47
|
| Rate for Payer: UHC Core |
$209.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.90
|
|
