|
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
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna American Axle |
$71.73
|
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: Aetna Medicare |
$55.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: BCBS Complete |
$44.14
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$77.25
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health SBD |
$69.53
|
| Rate for Payer: UMR Bronson Commercial |
$40.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.77
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$110.36
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
190617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$99.32 |
| Rate for Payer: Aetna American Axle |
$71.73
|
| Rate for Payer: Aetna Commercial |
$93.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$77.25
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: PHP Commercial |
$93.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.73
|
| Rate for Payer: Priority Health SBD |
$69.53
|
| Rate for Payer: UMR Bronson Commercial |
$48.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.77
|
|
|
VANCOMYCIN 500 MG/500 ML POCKET IRRIGATION FLUSH
|
Facility
|
OP
|
$37.83
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna American Axle |
$24.59
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
|
|
VANCOMYCIN 500 MG/500 ML POCKET IRRIGATION FLUSH
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
150800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna American Axle |
$24.59
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$32.86
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$29.57 |
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$32.86
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
301723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$29.57 |
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna American Axle |
$17.00
|
| Rate for Payer: Aetna American Axle |
$21.36
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna Medicare |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.29
|
| Rate for Payer: Healthscope Commercial |
$29.57
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$27.93
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.36
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: Priority Health SBD |
$16.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.62
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.31 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna American Axle |
$622.44
|
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna Medicare |
$478.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: BCBS Complete |
$383.04
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
| Rate for Payer: UMR Bronson Commercial |
$354.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.20
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna American Axle |
$622.44
|
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
| Rate for Payer: UMR Bronson Commercial |
$421.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.20
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$966.24
|
|
|
Service Code
|
NDC 67877075158
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.51 |
| Max. Negotiated Rate |
$869.62 |
| Rate for Payer: Aetna American Axle |
$628.06
|
| Rate for Payer: Aetna Commercial |
$821.30
|
| Rate for Payer: Aetna Medicare |
$483.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.06
|
| Rate for Payer: BCBS Complete |
$386.50
|
| Rate for Payer: Cash Price |
$772.99
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Cofinity Commercial |
$830.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.99
|
| Rate for Payer: Healthscope Commercial |
$869.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.30
|
| Rate for Payer: PHP Commercial |
$821.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.06
|
| Rate for Payer: Priority Health SBD |
$608.73
|
| Rate for Payer: UMR Bronson Commercial |
$357.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.68
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$966.24
|
|
|
Service Code
|
NDC 67877075158
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.15 |
| Max. Negotiated Rate |
$869.62 |
| Rate for Payer: Aetna American Axle |
$628.06
|
| Rate for Payer: Aetna Commercial |
$821.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.06
|
| Rate for Payer: Cash Price |
$772.99
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Cofinity Commercial |
$830.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.99
|
| Rate for Payer: Healthscope Commercial |
$869.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.30
|
| Rate for Payer: PHP Commercial |
$821.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.06
|
| Rate for Payer: Priority Health SBD |
$608.73
|
| Rate for Payer: UMR Bronson Commercial |
$425.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.68
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna American Axle |
$579.38
|
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
| Rate for Payer: UMR Bronson Commercial |
$329.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna American Axle |
$579.38
|
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$623.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
| Rate for Payer: UMR Bronson Commercial |
$392.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.52
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.45
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$188.69
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$170.62
|
| Rate for Payer: Aetna American Axle |
$53.14
|
| Rate for Payer: Aetna American Axle |
$47.53
|
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna Medicare |
$131.25
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$145.15
|
| Rate for Payer: Aetna Medicare |
$36.23
|
| Rate for Payer: Aetna Medicare |
$40.88
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: Aetna Medicare |
$36.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: BCBS Complete |
$116.12
|
| Rate for Payer: BCBS Complete |
$105.00
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$22.84
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Complete |
$29.25
|
| Rate for Payer: BCBS Complete |
$32.70
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$70.31
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$26.07
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Commercial |
$65.81
|
| Rate for Payer: Healthscope Commercial |
$73.58
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: PHP Commercial |
$69.49
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.14
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: Priority Health SBD |
$51.50
|
| Rate for Payer: Priority Health SBD |
$46.07
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$35.97
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: UMR Bronson Commercial |
$26.81
|
| Rate for Payer: UMR Bronson Commercial |
$27.05
|
| Rate for Payer: UMR Bronson Commercial |
$107.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.25
|
| Rate for Payer: UMR Bronson Commercial |
$21.13
|
| Rate for Payer: UMR Bronson Commercial |
$20.72
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$97.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$73.12
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$65.81 |
| Rate for Payer: Aetna American Axle |
$47.53
|
| Rate for Payer: Aetna American Axle |
$47.09
|
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$170.62
|
| Rate for Payer: Aetna American Axle |
$188.69
|
| Rate for Payer: Aetna American Axle |
$36.39
|
| Rate for Payer: Aetna American Axle |
$53.14
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$47.59
|
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$209.99
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Cofinity Commercial |
$183.74
|
| Rate for Payer: Cofinity Commercial |
$39.19
|
| Rate for Payer: Cofinity Commercial |
$26.07
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Cofinity Commercial |
$32.03
|
| Rate for Payer: Cofinity Commercial |
$225.74
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Cofinity Commercial |
$70.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$236.24
|
| Rate for Payer: Healthscope Commercial |
$73.58
|
| Rate for Payer: Healthscope Commercial |
$65.81
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Healthscope Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$62.15
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: PHP Commercial |
$47.59
|
| Rate for Payer: PHP Commercial |
$69.49
|
| Rate for Payer: PHP Commercial |
$223.12
|
| Rate for Payer: PHP Commercial |
$48.53
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$165.37
|
| Rate for Payer: Priority Health SBD |
$35.27
|
| Rate for Payer: Priority Health SBD |
$45.64
|
| Rate for Payer: Priority Health SBD |
$35.97
|
| Rate for Payer: Priority Health SBD |
$51.50
|
| Rate for Payer: Priority Health SBD |
$46.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.17
|
| Rate for Payer: UMR Bronson Commercial |
$127.73
|
| Rate for Payer: UMR Bronson Commercial |
$35.97
|
| Rate for Payer: UMR Bronson Commercial |
$25.12
|
| Rate for Payer: UMR Bronson Commercial |
$115.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna American Axle |
$6.75
|
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.79
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
OP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna American Axle |
$6.75
|
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.15
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.79
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN FORTIFIED 50 MG/ML OPHTHALMIC DROPS
|
Facility
|
OP
|
$29.09
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
500596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: Aetna American Axle |
$18.91
|
| Rate for Payer: Aetna Commercial |
$24.73
|
| Rate for Payer: Aetna Medicare |
$14.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.91
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: Cash Price |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$25.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$26.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.73
|
| Rate for Payer: PHP Commercial |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.91
|
| Rate for Payer: Priority Health SBD |
$18.33
|
| Rate for Payer: UMR Bronson Commercial |
$10.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.82
|
|
|
VANCOMYCIN FORTIFIED 50 MG/ML OPHTHALMIC DROPS
|
Facility
|
IP
|
$29.09
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
500596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: Aetna American Axle |
$18.91
|
| Rate for Payer: Aetna Commercial |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.91
|
| Rate for Payer: Cash Price |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$25.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$26.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.73
|
| Rate for Payer: PHP Commercial |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.91
|
| Rate for Payer: Priority Health SBD |
$18.33
|
| Rate for Payer: UMR Bronson Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.82
|
|
|
VANCOMYCIN IVPB (BMH IV-PREMIX)
|
Facility
|
IP
|
$118.11
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
180476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$106.30 |
| Rate for Payer: Aetna American Axle |
$76.77
|
| Rate for Payer: Aetna Commercial |
$100.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.77
|
| Rate for Payer: Cash Price |
$94.49
|
| Rate for Payer: Cofinity Commercial |
$101.57
|
| Rate for Payer: Cofinity Commercial |
$82.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.49
|
| Rate for Payer: Healthscope Commercial |
$106.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.39
|
| Rate for Payer: PHP Commercial |
$100.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.77
|
| Rate for Payer: Priority Health SBD |
$74.41
|
| Rate for Payer: UMR Bronson Commercial |
$51.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.58
|
|
|
VANCOMYCIN IVPB (BMH IV-PREMIX)
|
Facility
|
OP
|
$118.11
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
180476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$106.30 |
| Rate for Payer: Aetna American Axle |
$76.77
|
| Rate for Payer: Aetna Commercial |
$100.39
|
| Rate for Payer: Aetna Medicare |
$59.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.77
|
| Rate for Payer: BCBS Complete |
$47.24
|
| Rate for Payer: Cash Price |
$94.49
|
| Rate for Payer: Cofinity Commercial |
$101.57
|
| Rate for Payer: Cofinity Commercial |
$82.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.49
|
| Rate for Payer: Healthscope Commercial |
$106.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.39
|
| Rate for Payer: PHP Commercial |
$100.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.77
|
| Rate for Payer: Priority Health SBD |
$74.41
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.58
|
|
