|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$782.67
|
|
|
Service Code
|
NDC 0078-0423-15
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.37 |
| Max. Negotiated Rate |
$704.40 |
| Rate for Payer: Aetna American Axle |
$508.74
|
| Rate for Payer: Aetna Commercial |
$665.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.74
|
| Rate for Payer: Cash Price |
$626.14
|
| Rate for Payer: Cofinity Commercial |
$547.87
|
| Rate for Payer: Cofinity Commercial |
$673.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.14
|
| Rate for Payer: Healthscope Commercial |
$704.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$587.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$665.27
|
| Rate for Payer: PHP Commercial |
$665.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.87
|
| Rate for Payer: Priority Health SBD |
$493.08
|
| Rate for Payer: UMR Bronson Commercial |
$344.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$587.00
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
NDC 60687-623-11
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna American Axle |
$3.07
|
| Rate for Payer: Aetna Commercial |
$4.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.07
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.02
|
| Rate for Payer: PHP Commercial |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health SBD |
$2.98
|
| Rate for Payer: UMR Bronson Commercial |
$2.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.55
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$189.81
|
|
|
Service Code
|
NDC 55111-732-90
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$170.83 |
| Rate for Payer: Aetna American Axle |
$123.38
|
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.38
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cofinity Commercial |
$132.87
|
| Rate for Payer: Cofinity Commercial |
$163.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.85
|
| Rate for Payer: Healthscope Commercial |
$170.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.34
|
| Rate for Payer: PHP Commercial |
$161.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health SBD |
$119.58
|
| Rate for Payer: UMR Bronson Commercial |
$83.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.36
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$2,806.86
|
|
|
Service Code
|
NDC 0078-0358-34
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,235.02 |
| Max. Negotiated Rate |
$2,526.17 |
| Rate for Payer: Aetna American Axle |
$1,824.46
|
| Rate for Payer: Aetna Commercial |
$2,385.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,824.46
|
| Rate for Payer: Cash Price |
$2,245.49
|
| Rate for Payer: Cofinity Commercial |
$1,964.80
|
| Rate for Payer: Cofinity Commercial |
$2,413.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,245.49
|
| Rate for Payer: Healthscope Commercial |
$2,526.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,964.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,105.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,385.83
|
| Rate for Payer: PHP Commercial |
$2,385.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,964.80
|
| Rate for Payer: Priority Health SBD |
$1,768.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,235.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,105.14
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$188.96
|
|
|
Service Code
|
NDC 72819-182-09
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.14 |
| Max. Negotiated Rate |
$170.06 |
| Rate for Payer: Aetna American Axle |
$122.82
|
| Rate for Payer: Aetna Commercial |
$160.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.82
|
| Rate for Payer: Cash Price |
$151.17
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$162.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.17
|
| Rate for Payer: Healthscope Commercial |
$170.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.62
|
| Rate for Payer: PHP Commercial |
$160.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.27
|
| Rate for Payer: Priority Health SBD |
$119.04
|
| Rate for Payer: UMR Bronson Commercial |
$83.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.72
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$472.80
|
|
|
Service Code
|
NDC 60687-623-01
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna American Axle |
$307.32
|
| Rate for Payer: Aetna Commercial |
$401.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.32
|
| Rate for Payer: Cash Price |
$378.24
|
| Rate for Payer: Cofinity Commercial |
$330.96
|
| Rate for Payer: Cofinity Commercial |
$406.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.24
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.88
|
| Rate for Payer: PHP Commercial |
$401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.96
|
| Rate for Payer: Priority Health SBD |
$297.86
|
| Rate for Payer: UMR Bronson Commercial |
$208.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.60
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
OP
|
$19.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna American Axle |
$12.05
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Complete |
$7.73
|
| 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 |
$15.46
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.76
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna American Axle |
$11.47
|
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.42
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.50
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
|
|
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 |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| 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
|
IP
|
$116.28
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna American Axle |
$75.58
|
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| 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) |
$134.50
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$81.15
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| 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 |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| 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 |
$81.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| 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 |
$175.89
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.85
|
| 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 |
$81.15
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$73.26
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$51.01
|
| Rate for Payer: UMR Bronson Commercial |
$51.11
|
| Rate for Payer: UMR Bronson Commercial |
$51.16
|
| 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 |
$87.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$134.53
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$121.08 |
| Rate for Payer: Aetna American Axle |
$87.44
|
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna American Axle |
$458.62
|
| Rate for Payer: Aetna American Axle |
$457.12
|
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna Commercial |
$114.35
|
| Rate for Payer: Aetna Commercial |
$597.77
|
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| 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: Aetna New Business (MI Preferred) |
$458.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.12
|
| Rate for Payer: BCBS Complete |
$53.81
|
| Rate for Payer: BCBS Complete |
$46.37
|
| Rate for Payer: BCBS Complete |
$281.30
|
| Rate for Payer: BCBS Complete |
$282.23
|
| 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 |
$562.61
|
| 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 |
$107.62
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cofinity Commercial |
$606.79
|
| 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 |
$493.90
|
| 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: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Healthscope Commercial |
$104.54
|
| Rate for Payer: Healthscope Commercial |
$635.01
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Healthscope Commercial |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$632.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$597.77
|
| Rate for Payer: PHP Commercial |
$114.35
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$597.77
|
| Rate for Payer: PHP Commercial |
$599.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.17
|
| 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 |
$81.30
|
| Rate for Payer: Priority Health SBD |
$443.05
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$444.51
|
| Rate for Payer: UMR Bronson Commercial |
$49.78
|
| Rate for Payer: UMR Bronson Commercial |
$42.89
|
| Rate for Payer: UMR Bronson Commercial |
$260.21
|
| Rate for Payer: UMR Bronson Commercial |
$261.06
|
| Rate for Payer: UMR Bronson Commercial |
$42.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.90
|
|
|
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 |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| 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
|
$72.45
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.88 |
| 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 American Axle |
$47.53
|
| Rate for Payer: Aetna American Axle |
$46.28
|
| Rate for Payer: Aetna American Axle |
$53.14
|
| Rate for Payer: Aetna American Axle |
$188.69
|
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Healthscope Commercial |
$65.81
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$73.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.84
|
| 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 |
$217.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.15
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: PHP Commercial |
$69.49
|
| Rate for Payer: PHP Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.74
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$46.07
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: Priority Health SBD |
$51.50
|
| Rate for Payer: Priority Health SBD |
$44.86
|
| Rate for Payer: UMR Bronson Commercial |
$31.33
|
| Rate for Payer: UMR Bronson Commercial |
$115.50
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$127.73
|
| 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 |
$53.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$262.49
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.45 |
| 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 Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Complete |
$105.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| 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 |
$50.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| 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
|
Both
|
$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
|
|
