|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna American Axle |
$107.60
|
| Rate for Payer: Aetna American Axle |
$22.45
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$128.71
|
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna American Axle |
$42.67
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$29.36
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Commercial |
$55.79
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Aetna Medicare |
$35.23
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna Medicare |
$32.82
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna Medicare |
$99.01
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: BCBS Complete |
$79.21
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Complete |
$26.26
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Complete |
$13.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$27.63
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$27.63
|
| Rate for Payer: Cofinity Advantage |
$41.03
|
| Rate for Payer: Cofinity Advantage |
$24.18
|
| Rate for Payer: Cofinity Advantage |
$138.61
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Advantage |
$45.95
|
| Rate for Payer: Cofinity Advantage |
$49.31
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Healthscope Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$31.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$29.36
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$168.32
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$55.79
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: Priority Health SBD |
$41.35
|
| Rate for Payer: Priority Health SBD |
$21.76
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Priority Health SBD |
$124.75
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UMR Bronson Commercial |
$12.78
|
| Rate for Payer: UMR Bronson Commercial |
$21.69
|
| Rate for Payer: UMR Bronson Commercial |
$73.27
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: UMR Bronson Commercial |
$26.07
|
| Rate for Payer: UMR Bronson Commercial |
$24.29
|
| Rate for Payer: UMR Bronson Commercial |
$23.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$165.54
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Aetna American Axle |
$107.60
|
| Rate for Payer: Aetna American Axle |
$22.45
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna American Axle |
$42.67
|
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna American Axle |
$128.71
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$29.36
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Commercial |
$55.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$27.63
|
| Rate for Payer: Cash Price |
$158.42
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cofinity Advantage |
$45.95
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$138.61
|
| Rate for Payer: Cofinity Advantage |
$41.03
|
| Rate for Payer: Cofinity Advantage |
$24.18
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Advantage |
$49.31
|
| Rate for Payer: Cofinity Commercial |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.42
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.51
|
| Rate for Payer: PHP Commercial |
$168.32
|
| Rate for Payer: PHP Commercial |
$55.79
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Commercial |
$29.36
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Priority Health SBD |
$41.35
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Priority Health SBD |
$124.75
|
| Rate for Payer: Priority Health SBD |
$21.76
|
| Rate for Payer: UMR Bronson Commercial |
$31.00
|
| Rate for Payer: UMR Bronson Commercial |
$72.84
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: UMR Bronson Commercial |
$87.13
|
| Rate for Payer: UMR Bronson Commercial |
$27.83
|
| Rate for Payer: UMR Bronson Commercial |
$28.88
|
| Rate for Payer: UMR Bronson Commercial |
$15.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.84
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$180.15
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.27 |
| Max. Negotiated Rate |
$162.13 |
| Rate for Payer: Aetna American Axle |
$117.10
|
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.10
|
| Rate for Payer: Cash Price |
$144.12
|
| Rate for Payer: Cofinity Advantage |
$126.11
|
| Rate for Payer: Cofinity Commercial |
$154.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.12
|
| Rate for Payer: Healthscope Commercial |
$162.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.11
|
| Rate for Payer: PHP Commercial |
$153.13
|
| Rate for Payer: Priority Health SBD |
$113.49
|
| Rate for Payer: UMR Bronson Commercial |
$79.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.11
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| 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 Advantage |
$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 Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| 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 200 MG TABLET
|
Facility
|
OP
|
$180.15
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$162.13 |
| Rate for Payer: Aetna American Axle |
$117.10
|
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna Medicare |
$90.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.10
|
| Rate for Payer: BCBS Complete |
$72.06
|
| Rate for Payer: Cash Price |
$144.12
|
| Rate for Payer: Cofinity Advantage |
$126.11
|
| Rate for Payer: Cofinity Commercial |
$154.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.12
|
| Rate for Payer: Healthscope Commercial |
$162.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.11
|
| Rate for Payer: PHP Commercial |
$153.13
|
| Rate for Payer: Priority Health SBD |
$113.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.10
|
| Rate for Payer: UHC Core |
$93.86
|
| Rate for Payer: UHC Exchange |
$70.80
|
| Rate for Payer: UMR Bronson Commercial |
$66.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.11
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.05
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.51
|
| Rate for Payer: UHC Core |
$200.79
|
| Rate for Payer: UHC Exchange |
$151.46
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
IP
|
$966.59
|
|
|
Service Code
|
NDC 00378162693
|
| 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 Advantage |
$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 Commercial |
$821.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.94
|
| Rate for Payer: PHP Commercial |
$821.60
|
| 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
|
OP
|
$966.59
|
|
|
Service Code
|
NDC 00378162693
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.64 |
| Max. Negotiated Rate |
$869.93 |
| Rate for Payer: Aetna American Axle |
$628.28
|
| Rate for Payer: Aetna Commercial |
$821.60
|
| Rate for Payer: Aetna Medicare |
$483.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.28
|
| Rate for Payer: BCBS Complete |
$386.64
|
| Rate for Payer: Cash Price |
$773.27
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$773.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.94
|
| Rate for Payer: PHP Commercial |
$821.60
|
| Rate for Payer: Priority Health SBD |
$608.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.28
|
| Rate for Payer: UHC Core |
$503.59
|
| Rate for Payer: UHC Exchange |
$379.87
|
| Rate for Payer: UMR Bronson Commercial |
$357.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.94
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
IP
|
$199.88
|
|
|
Service Code
|
NDC 00049317030
|
| 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 Advantage |
$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 Commercial |
$169.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.91
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: Priority Health SBD |
$125.92
|
| Rate for Payer: UMR Bronson Commercial |
$87.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.91
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
OP
|
$199.88
|
|
|
Service Code
|
NDC 00049317030
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$179.89 |
| Rate for Payer: Aetna American Axle |
$129.92
|
| Rate for Payer: Aetna Commercial |
$169.90
|
| Rate for Payer: Aetna Medicare |
$99.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.92
|
| Rate for Payer: BCBS Complete |
$79.95
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$159.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.91
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: Priority Health SBD |
$125.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.92
|
| Rate for Payer: UHC Core |
$104.14
|
| Rate for Payer: UHC Exchange |
$78.55
|
| Rate for Payer: UMR Bronson Commercial |
$73.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.91
|
|
|
VORINOSTAT 100 MG CAPSULE
|
Facility
|
IP
|
$55,535.52
|
|
|
Service Code
|
NDC 00006056840
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24,435.63 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Advantage |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,205.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41,651.64
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UMR Bronson Commercial |
$24,435.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORINOSTAT 100 MG CAPSULE
|
Facility
|
OP
|
$55,535.52
|
|
|
Service Code
|
NDC 00006056840
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20,548.14 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna Medicare |
$27,767.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: BCBS Complete |
$22,214.21
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Advantage |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,428.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,205.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41,651.64
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,098.09
|
| Rate for Payer: UHC Core |
$28,934.01
|
| Rate for Payer: UHC Exchange |
$21,825.46
|
| Rate for Payer: UMR Bronson Commercial |
$20,548.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
IP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.39 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna American Axle |
$1,207.51
|
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,300.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,393.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UMR Bronson Commercial |
$817.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,393.28
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
OP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$687.35 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna American Axle |
$1,207.51
|
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna Medicare |
$928.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: BCBS Complete |
$743.08
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,300.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,393.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.51
|
| Rate for Payer: UHC Core |
$967.86
|
| Rate for Payer: UHC Exchange |
$730.08
|
| Rate for Payer: UMR Bronson Commercial |
$687.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,393.28
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
OP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$687.35 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna American Axle |
$1,207.51
|
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna Medicare |
$928.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: BCBS Complete |
$743.08
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,300.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,393.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.51
|
| Rate for Payer: UHC Core |
$967.86
|
| Rate for Payer: UHC Exchange |
$730.08
|
| Rate for Payer: UMR Bronson Commercial |
$687.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,393.28
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
IP
|
$1,857.70
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.39 |
| Max. Negotiated Rate |
$1,671.93 |
| Rate for Payer: Aetna American Axle |
$1,207.51
|
| Rate for Payer: Aetna Commercial |
$1,579.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.51
|
| Rate for Payer: Cash Price |
$1,486.16
|
| Rate for Payer: Cofinity Advantage |
$1,300.39
|
| Rate for Payer: Cofinity Commercial |
$1,597.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.16
|
| Rate for Payer: Healthscope Commercial |
$1,671.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,300.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,393.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,393.28
|
| Rate for Payer: PHP Commercial |
$1,579.05
|
| Rate for Payer: Priority Health SBD |
$1,170.35
|
| Rate for Payer: UMR Bronson Commercial |
$817.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,393.28
|
|
|
VULVECTOMY, RADICAL, PARTIAL;
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 56630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,084.62
|
| Rate for Payer: BCN Commercial |
$4,084.62
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,946.59
|
| Rate for Payer: BCN Commercial |
$3,946.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
VUTRISIRAN 25 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$262,572.20
|
|
|
Service Code
|
HCPCS J0225
|
| Hospital Charge Code |
200574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,625.08 |
| Max. Negotiated Rate |
$236,314.98 |
| Rate for Payer: Aetna American Axle |
$170,671.93
|
| Rate for Payer: Aetna Commercial |
$223,186.37
|
| Rate for Payer: Aetna Medicare |
$5,220.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170,671.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,274.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,274.09
|
| Rate for Payer: BCBS Complete |
$2,756.58
|
| Rate for Payer: BCBS MAPPO |
$5,019.27
|
| Rate for Payer: BCBS Trust/PPO |
$16,244.21
|
| Rate for Payer: BCN Commercial |
$16,244.21
|
| Rate for Payer: BCN Medicare Advantage |
$5,019.27
|
| Rate for Payer: Cash Price |
$210,057.76
|
| Rate for Payer: Cash Price |
$210,057.76
|
| Rate for Payer: Cofinity Advantage |
$183,800.54
|
| Rate for Payer: Cofinity Commercial |
$225,812.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210,057.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,019.27
|
| Rate for Payer: Healthscope Commercial |
$236,314.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183,800.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196,929.15
|
| Rate for Payer: Mclaren Medicaid |
$5,019.27
|
| Rate for Payer: Mclaren Medicare |
$5,019.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,270.23
|
| Rate for Payer: Meridian Medicaid |
$5,270.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,772.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,521.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223,186.37
|
| Rate for Payer: Nomi Health Commercial |
$15,057.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196,929.15
|
| Rate for Payer: PACE Medicare |
$4,768.31
|
| Rate for Payer: PACE SWMI |
$5,019.27
|
| Rate for Payer: PHP Commercial |
$223,186.37
|
| Rate for Payer: PHP Medicare Advantage |
$5,019.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,625.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,781.31
|
| Rate for Payer: Priority Health Medicare |
$5,019.27
|
| Rate for Payer: Priority Health SBD |
$165,420.49
|
| Rate for Payer: Priority Health Tiered Network |
$12,625.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,019.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,265.77
|
| Rate for Payer: UHC Core |
$8,265.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,019.27
|
| Rate for Payer: UHC Exchange |
$8,265.77
|
| Rate for Payer: UHC Medicaid |
$2,625.08
|
| Rate for Payer: UHCCP Medicaid |
$2,625.08
|
| Rate for Payer: UMR Bronson Commercial |
$97,151.71
|
| Rate for Payer: VA VA |
$5,019.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196,929.15
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 65162076110
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.65
|
| Rate for Payer: UHC Core |
$184.88
|
| Rate for Payer: UHC Exchange |
$139.46
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 65162076110
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00832121100
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00832121100
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.19
|
| Rate for Payer: UHC Core |
$142.02
|
| Rate for Payer: UHC Exchange |
$107.13
|
| Rate for Payer: UMR Bronson Commercial |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.77
|
| Rate for Payer: UHC Core |
$1.42
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
