|
VANCOMYCIN 100 MG/ML PF IV SOLN CUSTOM
|
Facility
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
OP
|
$116.15
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$104.54 |
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna American Axle |
$457.12
|
| Rate for Payer: Aetna American Axle |
$458.62
|
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Aetna Commercial |
$597.77
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: BCBS Complete |
$53.81
|
| Rate for Payer: BCBS Complete |
$46.37
|
| Rate for Payer: BCBS Complete |
$282.23
|
| Rate for Payer: BCBS Complete |
$281.30
|
| Rate for Payer: BCBS Complete |
$46.46
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$562.61
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$564.46
|
| Rate for Payer: Cash Price |
$562.61
|
| Rate for Payer: Cash Price |
$564.46
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Commercial |
$81.15
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$94.17
|
| Rate for Payer: Cofinity Commercial |
$492.28
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$493.90
|
| Rate for Payer: Cofinity Commercial |
$606.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.46
|
| Rate for Payer: Healthscope Commercial |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$632.93
|
| Rate for Payer: Healthscope Commercial |
$635.01
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$597.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.73
|
| Rate for Payer: PHP Commercial |
$114.35
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$597.77
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$599.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.90
|
| Rate for Payer: Priority Health SBD |
$443.05
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$444.51
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: UMR Bronson Commercial |
$260.21
|
| Rate for Payer: UMR Bronson Commercial |
$42.89
|
| Rate for Payer: UMR Bronson Commercial |
$42.98
|
| Rate for Payer: UMR Bronson Commercial |
$49.78
|
| Rate for Payer: UMR Bronson Commercial |
$261.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.18
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna American Axle |
$75.58
|
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cofinity Commercial |
$81.15
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.73
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$73.26
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$51.11
|
| Rate for Payer: UMR Bronson Commercial |
$51.16
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$51.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN 0.9 % SOD. CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$80.79
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
178591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$72.71 |
| Rate for Payer: Aetna American Axle |
$52.51
|
| Rate for Payer: Aetna Commercial |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.51
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cofinity Commercial |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$69.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.63
|
| Rate for Payer: Healthscope Commercial |
$72.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.67
|
| Rate for Payer: PHP Commercial |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.55
|
| Rate for Payer: Priority Health SBD |
$50.90
|
| Rate for Payer: UMR Bronson Commercial |
$35.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.59
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
IP
|
$84.70
|
|
|
Service Code
|
NDC 0009-0003-00
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna American Axle |
$55.06
|
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.06
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$59.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.29
|
| Rate for Payer: Priority Health SBD |
$53.36
|
| Rate for Payer: UMR Bronson Commercial |
$37.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
VANCOMYCIN 250 MG CAPSULE
|
Facility
IP
|
$3,698.60
|
|
|
Service Code
|
NDC 63323-339-20
|
| Hospital Charge Code |
11629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,627.38 |
| Max. Negotiated Rate |
$3,328.74 |
| Rate for Payer: Aetna American Axle |
$2,404.09
|
| Rate for Payer: Aetna Commercial |
$3,143.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,404.09
|
| Rate for Payer: Cash Price |
$2,958.88
|
| Rate for Payer: Cofinity Commercial |
$2,589.02
|
| Rate for Payer: Cofinity Commercial |
$3,180.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,958.88
|
| Rate for Payer: Healthscope Commercial |
$3,328.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,589.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,773.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,143.81
|
| Rate for Payer: PHP Commercial |
$3,143.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,589.02
|
| Rate for Payer: Priority Health SBD |
$2,330.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,627.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,773.95
|
|
|
VANCOMYCIN 500 MG/500 ML POCKET IRRIGATION FLUSH
|
Facility
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna American Axle |
$24.59
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.48
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$32.86
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$29.57 |
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.93
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
NDC 65628-208-10
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$427.68 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Aetna American Axle |
$631.80
|
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.80
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Cofinity Commercial |
$835.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.60
|
| Rate for Payer: Healthscope Commercial |
$874.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$680.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.20
|
| Rate for Payer: PHP Commercial |
$826.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.40
|
| Rate for Payer: Priority Health SBD |
$612.36
|
| Rate for Payer: UMR Bronson Commercial |
$427.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.00
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628-201-10
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna American Axle |
$622.44
|
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.32
|
| Rate for Payer: Priority Health SBD |
$603.29
|
| Rate for Payer: UMR Bronson Commercial |
$421.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.20
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
IP
|
$262.49
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$236.24 |
| Rate for Payer: Aetna American Axle |
$170.62
|
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna American Axle |
$188.69
|
| Rate for Payer: Aetna American Axle |
$46.28
|
| Rate for Payer: Aetna American Axle |
$47.53
|
| Rate for Payer: Aetna American Axle |
$53.14
|
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.28
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.40
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Commercial |
$73.58
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Healthscope Commercial |
$65.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.49
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Commercial |
$69.49
|
| Rate for Payer: PHP Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.18
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: Priority Health SBD |
$51.50
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: Priority Health SBD |
$46.07
|
| Rate for Payer: Priority Health SBD |
$44.86
|
| Rate for Payer: UMR Bronson Commercial |
$127.73
|
| Rate for Payer: UMR Bronson Commercial |
$115.50
|
| Rate for Payer: UMR Bronson Commercial |
$31.33
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$35.97
|
| Rate for Payer: UMR Bronson Commercial |
$32.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.84
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
OP
|
$72.45
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna American Axle |
$170.62
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: BCBS Complete |
$105.00
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.12
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: UMR Bronson Commercial |
$97.12
|
| Rate for Payer: UMR Bronson Commercial |
$26.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
IP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna American Axle |
$6.75
|
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: Priority Health SBD |
$6.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.78
|
|
|
VANCOMYCIN FORTIFIED 50 MG/ML OPHTHALMIC DROPS
|
Facility
IP
|
$29.09
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
500596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: Aetna American Axle |
$18.91
|
| Rate for Payer: Aetna Commercial |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.91
|
| Rate for Payer: Cash Price |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$25.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$26.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.73
|
| Rate for Payer: PHP Commercial |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health SBD |
$18.33
|
| Rate for Payer: UMR Bronson Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.82
|
|
|
VANCOMYCIN IVPB (BMH IV-PREMIX)
|
Facility
IP
|
$113.57
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
180476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.97 |
| Max. Negotiated Rate |
$102.21 |
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$97.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.86
|
| Rate for Payer: Healthscope Commercial |
$102.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.53
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.50
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: UMR Bronson Commercial |
$49.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.18
|
|
|
VANTAS IMPLANT
|
Professional
|
$3,334.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,333.60 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: BCBS Complete |
$1,333.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,333.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,533.64
|
|
|
VARENICLINE 1 MG TABLET
|
Facility
IP
|
$946.29
|
|
|
Service Code
|
NDC 70710-1614-6
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$416.37 |
| Max. Negotiated Rate |
$851.66 |
| Rate for Payer: Aetna American Axle |
$615.09
|
| Rate for Payer: Aetna Commercial |
$804.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.09
|
| Rate for Payer: Cash Price |
$757.03
|
| Rate for Payer: Cofinity Commercial |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$813.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.03
|
| Rate for Payer: Healthscope Commercial |
$851.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$662.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.35
|
| Rate for Payer: PHP Commercial |
$804.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.40
|
| Rate for Payer: Priority Health SBD |
$596.16
|
| Rate for Payer: UMR Bronson Commercial |
$416.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.72
|
|
|
VARENICLINE 1 MG TABLET
|
Facility
IP
|
$1,254.39
|
|
|
Service Code
|
NDC 49884-156-76
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$551.93 |
| Max. Negotiated Rate |
$1,128.95 |
| Rate for Payer: Aetna American Axle |
$815.35
|
| Rate for Payer: Aetna Commercial |
$1,066.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.35
|
| Rate for Payer: Cash Price |
$1,003.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.78
|
| Rate for Payer: Cofinity Commercial |
$878.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.51
|
| Rate for Payer: Healthscope Commercial |
$1,128.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$878.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,066.23
|
| Rate for Payer: PHP Commercial |
$1,066.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$878.07
|
| Rate for Payer: Priority Health SBD |
$790.27
|
| Rate for Payer: UMR Bronson Commercial |
$551.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.79
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP
|
Facility
IP
|
$455.21
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
14757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.29 |
| Max. Negotiated Rate |
$409.69 |
| Rate for Payer: Aetna American Axle |
$295.89
|
| Rate for Payer: Aetna Commercial |
$386.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.89
|
| Rate for Payer: Cash Price |
$364.17
|
| Rate for Payer: Cofinity Commercial |
$318.65
|
| Rate for Payer: Cofinity Commercial |
$391.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.17
|
| Rate for Payer: Healthscope Commercial |
$409.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.93
|
| Rate for Payer: PHP Commercial |
$386.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.65
|
| Rate for Payer: Priority Health SBD |
$286.78
|
| Rate for Payer: UMR Bronson Commercial |
$200.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.41
|
|
|
VARICELLA-ZOSTER IMMUNE GLOB-MALTOSE 125 UNIT/1.2 ML IM SOLUTION
|
Facility
OP
|
$5,528.28
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
169165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,234.00 |
| Max. Negotiated Rate |
$6,840.75 |
| Rate for Payer: Aetna American Axle |
$3,593.38
|
| Rate for Payer: Aetna Commercial |
$4,699.04
|
| Rate for Payer: Aetna Medicare |
$2,346.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,593.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,819.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,819.94
|
| Rate for Payer: BCBS Complete |
$1,295.82
|
| Rate for Payer: BCBS MAPPO |
$2,255.95
|
| Rate for Payer: BCBS Trust/PPO |
$6,840.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,255.95
|
| Rate for Payer: Cash Price |
$4,422.62
|
| Rate for Payer: Cash Price |
$4,422.62
|
| Rate for Payer: Cofinity Commercial |
$3,869.80
|
| Rate for Payer: Cofinity Commercial |
$4,754.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,422.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,255.95
|
| Rate for Payer: Healthscope Commercial |
$4,975.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,869.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,146.21
|
| Rate for Payer: Mclaren Medicaid |
$1,234.00
|
| Rate for Payer: Mclaren Medicare |
$2,255.95
|
| Rate for Payer: Meridian Medicaid |
$1,295.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,368.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,594.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,699.04
|
| Rate for Payer: PACE Medicare |
$2,143.15
|
| Rate for Payer: PACE SWMI |
$2,255.95
|
| Rate for Payer: PHP Commercial |
$4,699.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,255.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,234.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,869.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,018.33
|
| Rate for Payer: Priority Health Medicare |
$2,255.95
|
| Rate for Payer: Priority Health Narrow Network |
$4,814.66
|
| Rate for Payer: Priority Health SBD |
$3,482.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,255.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,255.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,323.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,045.46
|
| Rate for Payer: VA VA |
$2,255.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,146.21
|
|
|
VARICELLA-ZOSTER IMMUNE GLOB-MALTOSE 125 UNIT/1.2 ML IM SOLUTION
|
Facility
IP
|
$5,528.28
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
169165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,432.44 |
| Max. Negotiated Rate |
$4,975.45 |
| Rate for Payer: Aetna American Axle |
$3,593.38
|
| Rate for Payer: Aetna Commercial |
$4,699.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,593.38
|
| Rate for Payer: Cash Price |
$4,422.62
|
| Rate for Payer: Cofinity Commercial |
$3,869.80
|
| Rate for Payer: Cofinity Commercial |
$4,754.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,422.62
|
| Rate for Payer: Healthscope Commercial |
$4,975.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,869.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,146.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,699.04
|
| Rate for Payer: PHP Commercial |
$4,699.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,869.80
|
| Rate for Payer: Priority Health SBD |
$3,482.82
|
| Rate for Payer: UMR Bronson Commercial |
$2,432.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,146.21
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; ARTERIAL, OTHER THAN HEMORRHAGE OR TUMOR (EG, CONGENITAL OR ACQUIRED ARTERIAL MALFORMATIONS, ARTERIOVENOUS MALFORMATIONS, ARTERIOVENOUS FISTULAS, ANEURYSMS, PSEUDOANEURYSMS)
|
Facility
OP
|
$49,067.27
|
|
|
Service Code
|
CPT 37242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.18 |
| Max. Negotiated Rate |
$49,067.27 |
| Rate for Payer: Aetna Medicare |
$16,210.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$12,342.73
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,067.27
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$39,253.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.50
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,586.58
|
| Rate for Payer: UHC Exchange |
$453.18
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; VENOUS, OTHER THAN HEMORRHAGE (EG, CONGENITAL OR ACQUIRED VENOUS MALFORMATIONS, VENOUS AND CAPILLARY HEMANGIOMAS, VARICES, VARICOCELES)
|
Facility
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 37241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$407.01 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$11,155.47
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.71
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$407.01
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.61
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$226.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
