|
VITAMIN E (DL, ACETATE) 45 MG (100 UNIT) CAPSULE
|
Facility
IP
|
$35.25
|
|
|
Service Code
|
NDC 8068113400
|
| Hospital Charge Code |
115972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.96
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.68
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
IP
|
$15.11
|
|
|
Service Code
|
NDC 4110081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna American Axle |
$9.82
|
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$13.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.84
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.58
|
| Rate for Payer: Priority Health SBD |
$9.52
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.33
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
|
Facility
OP
|
$11,377.15
|
|
|
Service Code
|
CPT 67036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$870.67 |
| Max. Negotiated Rate |
$11,377.15 |
| Rate for Payer: Aetna Medicare |
$3,758.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,517.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,517.55
|
| Rate for Payer: BCBS Complete |
$2,075.90
|
| Rate for Payer: BCBS MAPPO |
$3,614.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,423.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,614.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,614.04
|
| Rate for Payer: Mclaren Medicaid |
$1,976.88
|
| Rate for Payer: Mclaren Medicare |
$3,614.04
|
| Rate for Payer: Meridian Medicaid |
$2,075.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,794.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,156.15
|
| Rate for Payer: PACE Medicare |
$3,433.34
|
| Rate for Payer: PACE SWMI |
$3,614.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,614.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,976.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,377.15
|
| Rate for Payer: Priority Health Medicare |
$3,614.04
|
| Rate for Payer: Priority Health Narrow Network |
$9,101.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,614.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.74
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,614.04
|
| Rate for Payer: UHC Exchange |
$870.67
|
| Rate for Payer: UHC Medicare Advantage |
$3,722.46
|
| Rate for Payer: VA VA |
$3,614.04
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
IP
|
$14.80
|
|
|
Service Code
|
NDC 4390036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
IP
|
$9.25
|
|
|
Service Code
|
NDC 9900-0005-76
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna American Axle |
$6.01
|
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.01
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.86
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.48
|
| Rate for Payer: Priority Health SBD |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$4.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
IP
|
$14.80
|
|
|
Service Code
|
NDC 4390036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
IP
|
$14.80
|
|
|
Service Code
|
NDC 4390036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
IP
|
$14.80
|
|
|
Service Code
|
NDC 4390036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
IP
|
$2,751.14
|
|
|
Service Code
|
NDC 65162-913-22
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,210.50 |
| Max. Negotiated Rate |
$2,476.03 |
| Rate for Payer: Aetna American Axle |
$1,788.24
|
| Rate for Payer: Aetna Commercial |
$2,338.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,788.24
|
| Rate for Payer: Cash Price |
$2,200.91
|
| Rate for Payer: Cofinity Commercial |
$1,925.80
|
| Rate for Payer: Cofinity Commercial |
$2,365.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.91
|
| Rate for Payer: Healthscope Commercial |
$2,476.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,925.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,063.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,338.47
|
| Rate for Payer: PHP Commercial |
$2,338.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.80
|
| Rate for Payer: Priority Health SBD |
$1,733.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,063.36
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
IP
|
$2,345.16
|
|
|
Service Code
|
NDC 43386-038-60
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,031.87 |
| Max. Negotiated Rate |
$2,110.64 |
| Rate for Payer: Aetna American Axle |
$1,524.35
|
| Rate for Payer: Aetna Commercial |
$1,993.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,524.35
|
| Rate for Payer: Cash Price |
$1,876.13
|
| Rate for Payer: Cofinity Commercial |
$1,641.61
|
| Rate for Payer: Cofinity Commercial |
$2,016.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,876.13
|
| Rate for Payer: Healthscope Commercial |
$2,110.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,641.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,758.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,993.39
|
| Rate for Payer: PHP Commercial |
$1,993.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.61
|
| Rate for Payer: Priority Health SBD |
$1,477.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,758.87
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
IP
|
$1,462.43
|
|
|
Service Code
|
NDC 0049-3160-44
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$643.47 |
| Max. Negotiated Rate |
$1,316.19 |
| Rate for Payer: Aetna American Axle |
$950.58
|
| Rate for Payer: Aetna Commercial |
$1,243.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$950.58
|
| Rate for Payer: Cash Price |
$1,169.94
|
| Rate for Payer: Cofinity Commercial |
$1,023.70
|
| Rate for Payer: Cofinity Commercial |
$1,257.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,169.94
|
| Rate for Payer: Healthscope Commercial |
$1,316.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,023.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,096.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,243.07
|
| Rate for Payer: PHP Commercial |
$1,243.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.70
|
| Rate for Payer: Priority Health SBD |
$921.33
|
| Rate for Payer: UMR Bronson Commercial |
$643.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,096.82
|
|
|
VORICONAZOLE 200 MG INHALATION SOLUTION
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
180485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UMR Bronson Commercial |
$48.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$90.03
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$81.03 |
| Rate for Payer: Aetna American Axle |
$58.52
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna American Axle |
$42.44
|
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Commercial |
$76.53
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$55.50
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.44
|
| Rate for Payer: Cash Price |
$52.23
|
| Rate for Payer: Cash Price |
$72.02
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$63.02
|
| Rate for Payer: Cofinity Commercial |
$77.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Healthscope Commercial |
$58.76
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$81.03
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Commercial |
$76.53
|
| Rate for Payer: PHP Commercial |
$55.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.03
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Priority Health SBD |
$56.72
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$39.61
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: UMR Bronson Commercial |
$31.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.52
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
IP
|
$180.58
|
|
|
Service Code
|
NDC 27241-063-03
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$162.52 |
| Rate for Payer: Aetna American Axle |
$117.38
|
| Rate for Payer: Aetna Commercial |
$153.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.38
|
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: Cofinity Commercial |
$126.41
|
| Rate for Payer: Cofinity Commercial |
$155.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.46
|
| Rate for Payer: Healthscope Commercial |
$162.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.49
|
| Rate for Payer: PHP Commercial |
$153.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.41
|
| Rate for Payer: Priority Health SBD |
$113.77
|
| Rate for Payer: UMR Bronson Commercial |
$79.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.44
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
IP
|
$385.40
|
|
|
Service Code
|
NDC 0049-3180-30
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.78
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
IP
|
$199.88
|
|
|
Service Code
|
NDC 0049-3170-30
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.95 |
| Max. Negotiated Rate |
$179.89 |
| Rate for Payer: Aetna American Axle |
$129.92
|
| Rate for Payer: Aetna Commercial |
$169.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.92
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cofinity Commercial |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$171.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.90
|
| Rate for Payer: Healthscope Commercial |
$179.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.90
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.92
|
| Rate for Payer: Priority Health SBD |
$125.92
|
| Rate for Payer: UMR Bronson Commercial |
$87.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.91
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
IP
|
$966.59
|
|
|
Service Code
|
NDC 0378-1626-93
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.30 |
| Max. Negotiated Rate |
$869.93 |
| Rate for Payer: Aetna American Axle |
$628.28
|
| Rate for Payer: Aetna Commercial |
$821.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.28
|
| Rate for Payer: Cash Price |
$773.27
|
| Rate for Payer: Cofinity Commercial |
$676.61
|
| Rate for Payer: Cofinity Commercial |
$831.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.27
|
| Rate for Payer: Healthscope Commercial |
$869.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$821.60
|
| Rate for Payer: PHP Commercial |
$821.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.61
|
| Rate for Payer: Priority Health SBD |
$608.95
|
| Rate for Payer: UMR Bronson Commercial |
$425.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.94
|
|
|
VORINOSTAT 100 MG CAPSULE
|
Facility
IP
|
$55,535.52
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24,435.63 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Commercial |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,205.19
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,874.86
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UMR Bronson Commercial |
$24,435.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 64764-730-30
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna American Axle |
$1,095.24
|
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,432.23
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.49
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
| Rate for Payer: UMR Bronson Commercial |
$741.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 64764-750-30
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna American Axle |
$1,095.24
|
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,432.23
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.49
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
| Rate for Payer: UMR Bronson Commercial |
$741.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$583.17 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,114.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.49
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$583.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
WARFARIN 1 MG TABLET
|
Facility
IP
|
$3.62
|
|
|
Service Code
|
NDC 0832-1211-89
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
WARFARIN 1 MG TABLET
|
Facility
IP
|
$361.90
|
|
|
Service Code
|
NDC 0832-1211-01
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.33
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
WARFARIN 1 MG TABLET
|
Facility
IP
|
$354.85
|
|
|
Service Code
|
NDC 65162-761-10
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.40
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 1 MG TABLET
|
Facility
IP
|
$272.60
|
|
|
Service Code
|
NDC 0832-1211-00
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.82
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
