|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Core |
$5.48
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Aetna American Axle |
$9.82
|
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna Medicare |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.33
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: Priority Health SBD |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.82
|
| Rate for Payer: UHC Core |
$7.87
|
| Rate for Payer: UHC Exchange |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.33
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 41100081122
|
| 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 Advantage |
$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 Commercial |
$12.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.33
|
| Rate for Payer: PHP Commercial |
$12.84
|
| 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
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
NDC 65197040010
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 65197040101
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna American Axle |
$10.91
|
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.91
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cofinity Advantage |
$11.75
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.59
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.91
|
| Rate for Payer: UHC Core |
$8.75
|
| Rate for Payer: UHC Exchange |
$6.60
|
| Rate for Payer: UMR Bronson Commercial |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.62
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.62
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna American Axle |
$6.01
|
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.01
|
| Rate for Payer: BCBS Complete |
$3.70
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cofinity Advantage |
$6.47
|
| 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 |
$6.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.94
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health SBD |
$5.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.01
|
| Rate for Payer: UHC Core |
$4.82
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 09900000576
|
| 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 Advantage |
$6.47
|
| 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 |
$6.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.94
|
| Rate for Payer: PHP Commercial |
$7.86
|
| 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
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.62
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$10.18
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna American Axle |
$6.62
|
| Rate for Payer: Aetna Commercial |
$8.65
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.62
|
| Rate for Payer: BCBS Complete |
$4.07
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cofinity Advantage |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$9.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.63
|
| Rate for Payer: PHP Commercial |
$8.65
|
| Rate for Payer: Priority Health SBD |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.62
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.63
|
|
|
VON WILLEBRAND FACTOR(RECOMB) 1,300 (+/-) UNIT RANGE INTRAVENOUS SOLN
|
Facility
|
OP
|
$6.34
|
|
|
Service Code
|
HCPCS J7179
|
| Hospital Charge Code |
179505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Aetna American Axle |
$4.12
|
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$1.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$5.95
|
| Rate for Payer: BCN Commercial |
$5.95
|
| Rate for Payer: BCN Medicare Advantage |
$1.83
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Advantage |
$4.44
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.83
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.75
|
| Rate for Payer: Mclaren Medicaid |
$1.83
|
| Rate for Payer: Mclaren Medicare |
$1.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.92
|
| Rate for Payer: Meridian Medicaid |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.39
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.75
|
| Rate for Payer: PACE Medicare |
$1.74
|
| Rate for Payer: PACE SWMI |
$1.83
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: PHP Medicare Advantage |
$1.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.85
|
| Rate for Payer: Priority Health Medicare |
$1.83
|
| Rate for Payer: Priority Health SBD |
$3.99
|
| Rate for Payer: Priority Health Tiered Network |
$4.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.83
|
| Rate for Payer: UHC Exchange |
$3.04
|
| Rate for Payer: UHC Medicaid |
$0.96
|
| Rate for Payer: UHCCP Medicaid |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: VA VA |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.75
|
|
|
VON WILLEBRAND FACTOR(RECOMB) 1,300 (+/-) UNIT RANGE INTRAVENOUS SOLN
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
HCPCS J7179
|
| Hospital Charge Code |
179505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna American Axle |
$4.12
|
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.12
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Advantage |
$4.44
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: Priority Health SBD |
$3.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.75
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,759.74
|
|
|
Service Code
|
NDC 65162091322
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,021.10 |
| Max. Negotiated Rate |
$2,483.77 |
| Rate for Payer: Aetna American Axle |
$1,793.83
|
| Rate for Payer: Aetna Commercial |
$2,345.78
|
| Rate for Payer: Aetna Medicare |
$1,379.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,793.83
|
| Rate for Payer: BCBS Complete |
$1,103.90
|
| Rate for Payer: Cash Price |
$2,207.79
|
| Rate for Payer: Cofinity Advantage |
$1,931.82
|
| Rate for Payer: Cofinity Commercial |
$2,373.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,207.79
|
| Rate for Payer: Healthscope Commercial |
$2,483.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,931.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,069.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,207.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,345.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,069.80
|
| Rate for Payer: PHP Commercial |
$2,345.78
|
| Rate for Payer: Priority Health SBD |
$1,738.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,793.83
|
| Rate for Payer: UHC Core |
$1,437.82
|
| Rate for Payer: UHC Exchange |
$1,084.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,021.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,069.80
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$1,593.41
|
|
|
Service Code
|
NDC 43386003860
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$701.10 |
| Max. Negotiated Rate |
$1,434.07 |
| Rate for Payer: Aetna American Axle |
$1,035.72
|
| Rate for Payer: Aetna Commercial |
$1,354.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.72
|
| Rate for Payer: Cash Price |
$1,274.73
|
| Rate for Payer: Cofinity Advantage |
$1,115.39
|
| Rate for Payer: Cofinity Commercial |
$1,370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,274.73
|
| Rate for Payer: Healthscope Commercial |
$1,434.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,115.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,195.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,195.06
|
| Rate for Payer: PHP Commercial |
$1,354.40
|
| Rate for Payer: Priority Health SBD |
$1,003.85
|
| Rate for Payer: UMR Bronson Commercial |
$701.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,195.06
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$1,751.58
|
|
|
Service Code
|
NDC 00049316044
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$648.08 |
| Max. Negotiated Rate |
$1,576.42 |
| Rate for Payer: Aetna American Axle |
$1,138.53
|
| Rate for Payer: Aetna Commercial |
$1,488.84
|
| Rate for Payer: Aetna Medicare |
$875.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.53
|
| Rate for Payer: BCBS Complete |
$700.63
|
| Rate for Payer: Cash Price |
$1,401.26
|
| Rate for Payer: Cofinity Advantage |
$1,226.11
|
| Rate for Payer: Cofinity Commercial |
$1,506.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.26
|
| Rate for Payer: Healthscope Commercial |
$1,576.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,226.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,401.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,488.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.68
|
| Rate for Payer: PHP Commercial |
$1,488.84
|
| Rate for Payer: Priority Health SBD |
$1,103.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.53
|
| Rate for Payer: UHC Core |
$912.57
|
| Rate for Payer: UHC Exchange |
$688.37
|
| Rate for Payer: UMR Bronson Commercial |
$648.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.68
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,759.74
|
|
|
Service Code
|
NDC 65162091322
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,214.29 |
| Max. Negotiated Rate |
$2,483.77 |
| Rate for Payer: Aetna American Axle |
$1,793.83
|
| Rate for Payer: Aetna Commercial |
$2,345.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,793.83
|
| Rate for Payer: Cash Price |
$2,207.79
|
| Rate for Payer: Cofinity Advantage |
$1,931.82
|
| Rate for Payer: Cofinity Commercial |
$2,373.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,207.79
|
| Rate for Payer: Healthscope Commercial |
$2,483.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,931.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,069.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,345.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,069.80
|
| Rate for Payer: PHP Commercial |
$2,345.78
|
| Rate for Payer: Priority Health SBD |
$1,738.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,214.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,069.80
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$1,593.41
|
|
|
Service Code
|
NDC 43386003860
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.56 |
| Max. Negotiated Rate |
$1,434.07 |
| Rate for Payer: Aetna American Axle |
$1,035.72
|
| Rate for Payer: Aetna Commercial |
$1,354.40
|
| Rate for Payer: Aetna Medicare |
$796.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.72
|
| Rate for Payer: BCBS Complete |
$637.36
|
| Rate for Payer: Cash Price |
$1,274.73
|
| Rate for Payer: Cofinity Advantage |
$1,115.39
|
| Rate for Payer: Cofinity Commercial |
$1,370.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,274.73
|
| Rate for Payer: Healthscope Commercial |
$1,434.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,115.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,195.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,274.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,195.06
|
| Rate for Payer: PHP Commercial |
$1,354.40
|
| Rate for Payer: Priority Health SBD |
$1,003.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.72
|
| Rate for Payer: UHC Core |
$830.17
|
| Rate for Payer: UHC Exchange |
$626.21
|
| Rate for Payer: UMR Bronson Commercial |
$589.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,195.06
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$1,751.58
|
|
|
Service Code
|
NDC 00049316044
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$770.70 |
| Max. Negotiated Rate |
$1,576.42 |
| Rate for Payer: Aetna American Axle |
$1,138.53
|
| Rate for Payer: Aetna Commercial |
$1,488.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.53
|
| Rate for Payer: Cash Price |
$1,401.26
|
| Rate for Payer: Cofinity Advantage |
$1,226.11
|
| Rate for Payer: Cofinity Commercial |
$1,506.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.26
|
| Rate for Payer: Healthscope Commercial |
$1,576.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,226.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,488.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.68
|
| Rate for Payer: PHP Commercial |
$1,488.84
|
| Rate for Payer: Priority Health SBD |
$1,103.50
|
| Rate for Payer: UMR Bronson Commercial |
$770.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.68
|
|
|
VORICONAZOLE 200 MG INHALATION SOLUTION
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
180485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$88.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.25
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UMR Bronson Commercial |
$41.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
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 Advantage |
$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 Commercial |
$94.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.25
|
| Rate for Payer: PHP Commercial |
$94.35
|
| 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
|
|
