|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 6025816001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
NDC 7733395125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.22
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$174.90
|
|
|
Service Code
|
NDC 7733395110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna American Axle |
$113.68
|
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.68
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.92
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.66
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.43
|
| Rate for Payer: Priority Health SBD |
$110.19
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 9629513796
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS
|
Facility
|
IP
|
$93.46
|
|
|
Service Code
|
NDC 7132180230
|
| Hospital Charge Code |
116319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna American Axle |
$60.75
|
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: Cash Price |
$74.77
|
| Rate for Payer: Cofinity Commercial |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$80.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.77
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.44
|
| Rate for Payer: PHP Commercial |
$79.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.42
|
| Rate for Payer: Priority Health SBD |
$58.88
|
| Rate for Payer: UMR Bronson Commercial |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.10
|
|
|
VITAMIN E (DL, ACETATE) 450 MG (1,000 UNIT) CAPSULE
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 904027746
|
| Hospital Charge Code |
152874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
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
|
$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 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 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
|
$70.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna American Axle |
$42.44
|
| Rate for Payer: Aetna American Axle |
$58.52
|
| Rate for Payer: Aetna Commercial |
$76.53
|
| Rate for Payer: Aetna Commercial |
$55.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.44
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$52.23
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$72.02
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$77.43
|
| Rate for Payer: Cofinity Commercial |
$63.02
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.02
|
| Rate for Payer: Healthscope Commercial |
$81.03
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$58.76
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| 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 |
$49.00
|
| 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 |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| 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: 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 |
$55.50
|
| Rate for Payer: PHP Commercial |
$76.53
|
| Rate for Payer: PHP Commercial |
$55.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.03
|
| 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 SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Priority Health SBD |
$56.72
|
| Rate for Payer: UMR Bronson Commercial |
$31.00
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: UMR Bronson Commercial |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: UMR Bronson Commercial |
$39.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.97
|
| 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 |
$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
|
$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
|
|
|
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
|
|
