|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$2,862.81
|
|
|
Service Code
|
NDC 00078035834
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,259.64 |
| Max. Negotiated Rate |
$2,576.53 |
| Rate for Payer: Aetna American Axle |
$1,860.83
|
| Rate for Payer: Aetna Commercial |
$2,433.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.83
|
| Rate for Payer: Cash Price |
$2,290.25
|
| Rate for Payer: Cofinity Commercial |
$2,003.97
|
| Rate for Payer: Cofinity Commercial |
$2,462.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,003.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,290.25
|
| Rate for Payer: Healthscope Commercial |
$2,576.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,003.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,147.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,433.39
|
| Rate for Payer: PHP Commercial |
$2,433.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.83
|
| Rate for Payer: Priority Health SBD |
$1,803.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,147.11
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$2,862.81
|
|
|
Service Code
|
NDC 00078035834
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,059.24 |
| Max. Negotiated Rate |
$2,576.53 |
| Rate for Payer: Aetna American Axle |
$1,860.83
|
| Rate for Payer: Aetna Commercial |
$2,433.39
|
| Rate for Payer: Aetna Medicare |
$1,431.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.83
|
| Rate for Payer: BCBS Complete |
$1,145.12
|
| Rate for Payer: Cash Price |
$2,290.25
|
| Rate for Payer: Cofinity Commercial |
$2,003.97
|
| Rate for Payer: Cofinity Commercial |
$2,462.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,003.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,290.25
|
| Rate for Payer: Healthscope Commercial |
$2,576.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,003.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,147.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,433.39
|
| Rate for Payer: PHP Commercial |
$2,433.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.83
|
| Rate for Payer: Priority Health SBD |
$1,803.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,059.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,147.11
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$189.81
|
|
|
Service Code
|
NDC 55111073290
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$170.83 |
| Rate for Payer: Aetna American Axle |
$123.38
|
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: Aetna Medicare |
$94.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.38
|
| Rate for Payer: BCBS Complete |
$75.92
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cofinity Commercial |
$132.87
|
| Rate for Payer: Cofinity Commercial |
$163.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.85
|
| Rate for Payer: Healthscope Commercial |
$170.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.34
|
| Rate for Payer: PHP Commercial |
$161.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$119.58
|
| Rate for Payer: UMR Bronson Commercial |
$70.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.36
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 60687062311
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna American Axle |
$3.11
|
| Rate for Payer: Aetna Commercial |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.11
|
| Rate for Payer: Cash Price |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$4.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.83
|
| Rate for Payer: Healthscope Commercial |
$4.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.07
|
| Rate for Payer: PHP Commercial |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.11
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.59
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 60687062311
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna American Axle |
$3.11
|
| Rate for Payer: Aetna Commercial |
$4.07
|
| Rate for Payer: Aetna Medicare |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.11
|
| Rate for Payer: BCBS Complete |
$1.92
|
| Rate for Payer: Cash Price |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$4.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.83
|
| Rate for Payer: Healthscope Commercial |
$4.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.07
|
| Rate for Payer: PHP Commercial |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.11
|
| Rate for Payer: Priority Health SBD |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.59
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$188.96
|
|
|
Service Code
|
NDC 72819018209
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.14 |
| Max. Negotiated Rate |
$170.06 |
| Rate for Payer: Aetna American Axle |
$122.82
|
| Rate for Payer: Aetna Commercial |
$160.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.82
|
| Rate for Payer: Cash Price |
$151.17
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$162.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.17
|
| Rate for Payer: Healthscope Commercial |
$170.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.62
|
| Rate for Payer: PHP Commercial |
$160.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.82
|
| Rate for Payer: Priority Health SBD |
$119.04
|
| Rate for Payer: UMR Bronson Commercial |
$83.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.72
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$478.08
|
|
|
Service Code
|
NDC 60687062301
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Aetna American Axle |
$310.75
|
| Rate for Payer: Aetna Commercial |
$406.37
|
| Rate for Payer: Aetna Medicare |
$239.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.75
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$334.66
|
| Rate for Payer: Cofinity Commercial |
$411.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$334.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.46
|
| Rate for Payer: Healthscope Commercial |
$430.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.37
|
| Rate for Payer: PHP Commercial |
$406.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.75
|
| Rate for Payer: Priority Health SBD |
$301.19
|
| Rate for Payer: UMR Bronson Commercial |
$176.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.56
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$478.08
|
|
|
Service Code
|
NDC 60687062301
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.36 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Aetna American Axle |
$310.75
|
| Rate for Payer: Aetna Commercial |
$406.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.75
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$334.66
|
| Rate for Payer: Cofinity Commercial |
$411.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$334.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.46
|
| Rate for Payer: Healthscope Commercial |
$430.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.37
|
| Rate for Payer: PHP Commercial |
$406.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.75
|
| Rate for Payer: Priority Health SBD |
$301.19
|
| Rate for Payer: UMR Bronson Commercial |
$210.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.56
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$188.96
|
|
|
Service Code
|
NDC 72819018209
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.92 |
| Max. Negotiated Rate |
$170.06 |
| Rate for Payer: Aetna American Axle |
$122.82
|
| Rate for Payer: Aetna Commercial |
$160.62
|
| Rate for Payer: Aetna Medicare |
$94.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.82
|
| Rate for Payer: BCBS Complete |
$75.58
|
| Rate for Payer: Cash Price |
$151.17
|
| Rate for Payer: Cofinity Commercial |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$162.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.17
|
| Rate for Payer: Healthscope Commercial |
$170.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.62
|
| Rate for Payer: PHP Commercial |
$160.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.82
|
| Rate for Payer: Priority Health SBD |
$119.04
|
| Rate for Payer: UMR Bronson Commercial |
$69.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.72
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
IP
|
$189.81
|
|
|
Service Code
|
NDC 55111073290
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$170.83 |
| Rate for Payer: Aetna American Axle |
$123.38
|
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.38
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cofinity Commercial |
$132.87
|
| Rate for Payer: Cofinity Commercial |
$163.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.85
|
| Rate for Payer: Healthscope Commercial |
$170.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.34
|
| Rate for Payer: PHP Commercial |
$161.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$119.58
|
| Rate for Payer: UMR Bronson Commercial |
$83.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.36
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna American Axle |
$12.05
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna American Axle |
$11.47
|
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Aetna Medicare |
$8.82
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Aetna Medicare |
$9.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$6.86
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.90
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna American Axle |
$11.47
|
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna American Axle |
$20.18
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$26.69
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$27.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health SBD |
$19.56
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: Priority Health SBD |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83.80
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna American Axle |
$54.47
|
| Rate for Payer: Aetna American Axle |
$75.78
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$457.12
|
| Rate for Payer: Aetna American Axle |
$41.42
|
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna American Axle |
$458.62
|
| Rate for Payer: Aetna Commercial |
$71.23
|
| Rate for Payer: Aetna Commercial |
$99.10
|
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna Commercial |
$597.77
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna Medicare |
$352.79
|
| Rate for Payer: Aetna Medicare |
$41.90
|
| Rate for Payer: Aetna Medicare |
$351.63
|
| Rate for Payer: Aetna Medicare |
$58.30
|
| Rate for Payer: Aetna Medicare |
$31.86
|
| Rate for Payer: Aetna Medicare |
$58.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.42
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS Complete |
$46.46
|
| Rate for Payer: BCBS Complete |
$281.30
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Complete |
$46.64
|
| Rate for Payer: BCBS Complete |
$33.52
|
| Rate for Payer: BCBS Complete |
$282.23
|
| Rate for Payer: Cash Price |
$564.46
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$93.27
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: Cash Price |
$562.61
|
| Rate for Payer: Cash Price |
$67.04
|
| Rate for Payer: Cofinity Commercial |
$493.90
|
| Rate for Payer: Cofinity Commercial |
$100.27
|
| Rate for Payer: Cofinity Commercial |
$606.79
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$492.28
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Cofinity Commercial |
$58.66
|
| Rate for Payer: Cofinity Commercial |
$81.61
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$44.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$492.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.61
|
| Rate for Payer: Healthscope Commercial |
$104.53
|
| Rate for Payer: Healthscope Commercial |
$75.42
|
| Rate for Payer: Healthscope Commercial |
$635.01
|
| Rate for Payer: Healthscope Commercial |
$57.36
|
| Rate for Payer: Healthscope Commercial |
$104.93
|
| Rate for Payer: Healthscope Commercial |
$632.93
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.61
|
| 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 |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$599.73
|
| Rate for Payer: PHP Commercial |
$597.77
|
| Rate for Payer: PHP Commercial |
$71.23
|
| Rate for Payer: PHP Commercial |
$99.10
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$54.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.78
|
| Rate for Payer: Priority Health SBD |
$52.79
|
| Rate for Payer: Priority Health SBD |
$444.51
|
| Rate for Payer: Priority Health SBD |
$40.15
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$443.05
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$73.45
|
| Rate for Payer: UMR Bronson Commercial |
$43.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.58
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: UMR Bronson Commercial |
$42.98
|
| Rate for Payer: UMR Bronson Commercial |
$261.06
|
| Rate for Payer: UMR Bronson Commercial |
$260.21
|
| Rate for Payer: UMR Bronson Commercial |
$31.01
|
| 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 |
$87.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.11
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$75.78
|
| Rate for Payer: Aetna American Axle |
$75.50
|
| Rate for Payer: Aetna American Axle |
$41.42
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: Aetna Commercial |
$99.10
|
| Rate for Payer: Aetna Commercial |
$98.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Cash Price |
$93.27
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$44.61
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$100.27
|
| Rate for Payer: Cofinity Commercial |
$81.61
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$99.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.27
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$104.53
|
| Rate for Payer: Healthscope Commercial |
$104.93
|
| Rate for Payer: Healthscope Commercial |
$57.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$54.17
|
| Rate for Payer: PHP Commercial |
$98.73
|
| Rate for Payer: PHP Commercial |
$99.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.50
|
| Rate for Payer: Priority Health SBD |
$40.15
|
| Rate for Payer: Priority Health SBD |
$73.17
|
| Rate for Payer: Priority Health SBD |
$73.45
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$28.04
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: UMR Bronson Commercial |
$51.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna American Axle |
$44.84
|
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health SBD |
$43.46
|
| Rate for Payer: UMR Bronson Commercial |
$30.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
|
|
VANCOMYCIN 1.25 GRAM/250 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna American Axle |
$44.84
|
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$34.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.84
|
| Rate for Payer: Priority Health SBD |
$43.46
|
| Rate for Payer: UMR Bronson Commercial |
$25.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$30.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$96.57
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna American Axle |
$62.77
|
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna Medicare |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: BCBS Complete |
$38.63
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health SBD |
$60.84
|
| Rate for Payer: UMR Bronson Commercial |
$35.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.43
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.49 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna American Axle |
$62.77
|
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.77
|
| Rate for Payer: Priority Health SBD |
$60.84
|
| Rate for Payer: UMR Bronson Commercial |
$42.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.43
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$55.18
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna American Axle |
$35.87
|
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.87
|
| Rate for Payer: Priority Health SBD |
$34.76
|
| Rate for Payer: UMR Bronson Commercial |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.38
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$55.18
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
189876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna American Axle |
$35.87
|
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: BCBS Complete |
$22.07
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.87
|
| Rate for Payer: Priority Health SBD |
$34.76
|
| Rate for Payer: UMR Bronson Commercial |
$20.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.38
|
|
|
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 Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| 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: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
| Rate for Payer: UMR Bronson Commercial |
$31.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
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 Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| 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: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| 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 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 Commercial |
$2,589.02
|
| Rate for Payer: Cofinity Commercial |
$3,180.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,589.02
|
| 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: PHP Commercial |
$3,143.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,404.09
|
| 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
|
|
