|
VANCOMYCIN 1000 MG IVPB (BMH IV-PREMIX)
|
Facility
|
OP
|
$113.57
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
180476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$102.21 |
| Rate for Payer: Aetna American Axle |
$73.82
|
| Rate for Payer: Aetna Commercial |
$96.53
|
| Rate for Payer: Aetna Medicare |
$56.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: BCBS Complete |
$45.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$90.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.18
|
| Rate for Payer: PHP Commercial |
$96.53
|
| Rate for Payer: Priority Health SBD |
$71.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.18
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$115.93
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna American Axle |
$80.50
|
| Rate for Payer: Aetna American Axle |
$78.01
|
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna Commercial |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.01
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$99.08
|
| Rate for Payer: Cofinity Advantage |
$86.69
|
| Rate for Payer: Cofinity Advantage |
$81.15
|
| Rate for Payer: Cofinity Advantage |
$84.01
|
| Rate for Payer: Cofinity Commercial |
$106.51
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.08
|
| Rate for Payer: Healthscope Commercial |
$108.02
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.89
|
| Rate for Payer: PHP Commercial |
$102.02
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$105.27
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$75.61
|
| Rate for Payer: Priority Health SBD |
$78.03
|
| Rate for Payer: UMR Bronson Commercial |
$51.01
|
| Rate for Payer: UMR Bronson Commercial |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.89
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$120.02
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Aetna American Axle |
$78.01
|
| Rate for Payer: Aetna American Axle |
$457.12
|
| Rate for Payer: Aetna American Axle |
$458.62
|
| Rate for Payer: Aetna American Axle |
$75.35
|
| Rate for Payer: Aetna American Axle |
$54.47
|
| Rate for Payer: Aetna American Axle |
$80.50
|
| Rate for Payer: Aetna Commercial |
$71.23
|
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Aetna Commercial |
$105.27
|
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna Commercial |
$597.77
|
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Medicare |
$57.97
|
| Rate for Payer: Aetna Medicare |
$60.01
|
| Rate for Payer: Aetna Medicare |
$61.92
|
| Rate for Payer: Aetna Medicare |
$41.90
|
| Rate for Payer: Aetna Medicare |
$352.79
|
| Rate for Payer: Aetna Medicare |
$351.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.12
|
| Rate for Payer: BCBS Complete |
$49.54
|
| Rate for Payer: BCBS Complete |
$48.01
|
| 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 |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$99.08
|
| Rate for Payer: Cash Price |
$99.08
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$67.04
|
| 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 |
$562.61
|
| Rate for Payer: Cofinity Advantage |
$492.28
|
| Rate for Payer: Cofinity Advantage |
$86.69
|
| Rate for Payer: Cofinity Advantage |
$58.66
|
| Rate for Payer: Cofinity Advantage |
$81.15
|
| Rate for Payer: Cofinity Advantage |
$84.01
|
| Rate for Payer: Cofinity Advantage |
$493.90
|
| Rate for Payer: Cofinity Commercial |
$606.79
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$106.51
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| 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 |
$67.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.46
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Healthscope Commercial |
$635.01
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Commercial |
$632.93
|
| Rate for Payer: Healthscope Commercial |
$75.42
|
| Rate for Payer: Healthscope Commercial |
$108.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.01
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$493.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$527.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.89
|
| Rate for Payer: PHP Commercial |
$102.02
|
| Rate for Payer: PHP Commercial |
$105.27
|
| Rate for Payer: PHP Commercial |
$597.77
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$599.73
|
| Rate for Payer: PHP Commercial |
$71.23
|
| Rate for Payer: Priority Health SBD |
$443.05
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Priority Health SBD |
$75.61
|
| Rate for Payer: Priority Health SBD |
$52.79
|
| Rate for Payer: Priority Health SBD |
$78.03
|
| Rate for Payer: Priority Health SBD |
$444.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$260.21
|
| Rate for Payer: UMR Bronson Commercial |
$261.06
|
| Rate for Payer: UMR Bronson Commercial |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$42.89
|
| Rate for Payer: UMR Bronson Commercial |
$31.01
|
| Rate for Payer: UMR Bronson Commercial |
$45.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.45
|
| 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 |
$90.02
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
VANCOMYCIN 1 G POWDER (INTRA-OP)
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
154997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
VANCOMYCIN 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna American Axle |
$55.05
|
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$72.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.52
|
| Rate for Payer: PHP Commercial |
$72.00
|
| 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 1 G WITH GELATIN POWDER 1 G IN 6ML NS IRRIGATION
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
NDC 00009000300
|
| Hospital Charge Code |
500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna American Axle |
$55.05
|
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$67.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.52
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health SBD |
$53.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.05
|
| Rate for Payer: UHC Core |
$44.13
|
| Rate for Payer: UHC Exchange |
$33.29
|
| Rate for Payer: UMR Bronson Commercial |
$31.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
VANCOMYCIN 250 MG CAPSULE
|
Facility
|
OP
|
$3,698.60
|
|
|
Service Code
|
NDC 63323033920
|
| Hospital Charge Code |
11629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,368.48 |
| 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 Medicare |
$1,849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,404.09
|
| Rate for Payer: BCBS Complete |
$1,479.44
|
| Rate for Payer: Cash Price |
$2,958.88
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2,958.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,143.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,773.95
|
| Rate for Payer: PHP Commercial |
$3,143.81
|
| Rate for Payer: Priority Health SBD |
$2,330.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,404.09
|
| Rate for Payer: UHC Core |
$1,926.97
|
| Rate for Payer: UHC Exchange |
$1,453.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,773.95
|
|
|
VANCOMYCIN 250 MG CAPSULE
|
Facility
|
IP
|
$3,698.60
|
|
|
Service Code
|
NDC 63323033920
|
| 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 Advantage |
$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 Commercial |
$3,143.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,773.95
|
| Rate for Payer: PHP Commercial |
$3,143.81
|
| 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
|
OP
|
$37.83
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
150800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna American Axle |
$24.59
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
|
|
VANCOMYCIN 500 MG/500 ML POCKET IRRIGATION FLUSH
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J3373
|
| 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 Advantage |
$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 Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: PHP Commercial |
$32.16
|
| 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 MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$32.86
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$29.57 |
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$26.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.64
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$32.86
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
301723
|
|
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 Advantage |
$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 Commercial |
$27.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.64
|
| Rate for Payer: PHP Commercial |
$27.93
|
| 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 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna American Axle |
$12.15
|
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Advantage |
$13.09
|
| Rate for Payer: Cofinity Advantage |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health SBD |
$11.78
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna American Axle |
$12.15
|
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Advantage |
$23.00
|
| Rate for Payer: Cofinity Advantage |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.64
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: Priority Health SBD |
$11.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,337.76
|
|
|
Service Code
|
NDC 62559083003
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.97 |
| Max. Negotiated Rate |
$1,203.98 |
| Rate for Payer: Aetna American Axle |
$869.54
|
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| Rate for Payer: Aetna Medicare |
$668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.54
|
| Rate for Payer: BCBS Complete |
$535.10
|
| Rate for Payer: Cash Price |
$1,070.21
|
| Rate for Payer: Cofinity Advantage |
$936.43
|
| Rate for Payer: Cofinity Commercial |
$1,150.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.21
|
| Rate for Payer: Healthscope Commercial |
$1,203.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,070.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.32
|
| Rate for Payer: PHP Commercial |
$1,137.10
|
| Rate for Payer: Priority Health SBD |
$842.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.54
|
| Rate for Payer: UHC Core |
$696.97
|
| Rate for Payer: UHC Exchange |
$525.74
|
| Rate for Payer: UMR Bronson Commercial |
$494.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.32
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna American Axle |
$579.38
|
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Advantage |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$668.52
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health SBD |
$561.56
|
| Rate for Payer: UMR Bronson Commercial |
$392.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,048.32
|
|
|
Service Code
|
NDC 67877075158
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.26 |
| Max. Negotiated Rate |
$943.49 |
| Rate for Payer: Aetna American Axle |
$681.41
|
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.41
|
| Rate for Payer: Cash Price |
$838.66
|
| Rate for Payer: Cofinity Advantage |
$733.82
|
| Rate for Payer: Cofinity Commercial |
$901.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.66
|
| Rate for Payer: Healthscope Commercial |
$943.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.24
|
| Rate for Payer: PHP Commercial |
$891.07
|
| Rate for Payer: Priority Health SBD |
$660.44
|
| Rate for Payer: UMR Bronson Commercial |
$461.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.24
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| 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 Advantage |
$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 Commercial |
$813.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.20
|
| Rate for Payer: PHP Commercial |
$813.96
|
| 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 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,048.32
|
|
|
Service Code
|
NDC 67877075158
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.88 |
| Max. Negotiated Rate |
$943.49 |
| Rate for Payer: Aetna American Axle |
$681.41
|
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Medicare |
$524.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.41
|
| Rate for Payer: BCBS Complete |
$419.33
|
| Rate for Payer: Cash Price |
$838.66
|
| Rate for Payer: Cofinity Advantage |
$733.82
|
| Rate for Payer: Cofinity Commercial |
$901.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.66
|
| Rate for Payer: Healthscope Commercial |
$943.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$838.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.24
|
| Rate for Payer: PHP Commercial |
$891.07
|
| Rate for Payer: Priority Health SBD |
$660.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.41
|
| Rate for Payer: UHC Core |
$546.17
|
| Rate for Payer: UHC Exchange |
$411.99
|
| Rate for Payer: UMR Bronson Commercial |
$387.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.24
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.31 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna American Axle |
$622.44
|
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna Medicare |
$478.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: BCBS Complete |
$383.04
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$766.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.20
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health SBD |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.44
|
| Rate for Payer: UHC Core |
$498.91
|
| Rate for Payer: UHC Exchange |
$376.34
|
| Rate for Payer: UMR Bronson Commercial |
$354.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.20
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,337.76
|
|
|
Service Code
|
NDC 62559083003
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$588.61 |
| Max. Negotiated Rate |
$1,203.98 |
| Rate for Payer: Aetna American Axle |
$869.54
|
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.54
|
| Rate for Payer: Cash Price |
$1,070.21
|
| Rate for Payer: Cofinity Advantage |
$936.43
|
| Rate for Payer: Cofinity Commercial |
$1,150.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.21
|
| Rate for Payer: Healthscope Commercial |
$1,203.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.32
|
| Rate for Payer: PHP Commercial |
$1,137.10
|
| Rate for Payer: Priority Health SBD |
$842.79
|
| Rate for Payer: UMR Bronson Commercial |
$588.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.32
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna American Axle |
$579.38
|
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Advantage |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$713.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$668.52
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health SBD |
$561.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.38
|
| Rate for Payer: UHC Core |
$464.40
|
| Rate for Payer: UHC Exchange |
$350.30
|
| Rate for Payer: UMR Bronson Commercial |
$329.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.10
|
|
|
Service Code
|
HCPCS J3376
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cofinity Advantage |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.83
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: Priority Health SBD |
$35.97
|
| Rate for Payer: UMR Bronson Commercial |
$25.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$81.53
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$73.38 |
| Rate for Payer: Aetna American Axle |
$52.99
|
| Rate for Payer: Aetna American Axle |
$49.26
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna American Axle |
$47.53
|
| Rate for Payer: Aetna American Axle |
$170.62
|
| Rate for Payer: Aetna American Axle |
$188.69
|
| Rate for Payer: Aetna American Axle |
$64.21
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$64.42
|
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Commercial |
$83.97
|
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna Medicare |
$145.15
|
| Rate for Payer: Aetna Medicare |
$40.77
|
| Rate for Payer: Aetna Medicare |
$131.25
|
| Rate for Payer: Aetna Medicare |
$36.56
|
| Rate for Payer: Aetna Medicare |
$36.23
|
| Rate for Payer: Aetna Medicare |
$49.40
|
| Rate for Payer: Aetna Medicare |
$37.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.53
|
| Rate for Payer: BCBS Complete |
$39.52
|
| Rate for Payer: BCBS Complete |
$30.32
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Complete |
$105.00
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$116.12
|
| Rate for Payer: BCBS Complete |
$32.61
|
| Rate for Payer: BCBS Complete |
$29.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$60.63
|
| Rate for Payer: Cash Price |
$60.63
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cash Price |
$79.03
|
| Rate for Payer: Cofinity Advantage |
$53.05
|
| Rate for Payer: Cofinity Advantage |
$69.15
|
| Rate for Payer: Cofinity Advantage |
$26.07
|
| Rate for Payer: Cofinity Advantage |
$51.18
|
| Rate for Payer: Cofinity Advantage |
$57.07
|
| Rate for Payer: Cofinity Advantage |
$50.72
|
| Rate for Payer: Cofinity Advantage |
$183.74
|
| Rate for Payer: Cofinity Advantage |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$70.12
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.22
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Commercial |
$73.38
|
| Rate for Payer: Healthscope Commercial |
$68.21
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Healthscope Commercial |
$65.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| 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 |
$53.05
|
| 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: Lakeland Regional Health Systems Commercial |
$61.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.94
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: PHP Commercial |
$64.42
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$83.97
|
| Rate for Payer: PHP Commercial |
$69.30
|
| Rate for Payer: PHP Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$62.24
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: Priority Health SBD |
$47.75
|
| Rate for Payer: Priority Health SBD |
$51.36
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: Priority Health SBD |
$46.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.17
|
| Rate for Payer: UMR Bronson Commercial |
$36.55
|
| Rate for Payer: UMR Bronson Commercial |
$27.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$28.04
|
| Rate for Payer: UMR Bronson Commercial |
$97.12
|
| Rate for Payer: UMR Bronson Commercial |
$107.41
|
| Rate for Payer: UMR Bronson Commercial |
$26.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.15
|
|
