|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.69 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna American Axle |
$329.73
|
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna Medicare |
$253.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: BCBS Complete |
$202.91
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Commercial |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.82
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.19
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.73
|
| Rate for Payer: Priority Health SBD |
$319.59
|
| Rate for Payer: UMR Bronson Commercial |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$107.63
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$96.87 |
| Rate for Payer: Aetna American Axle |
$69.96
|
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.96
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cofinity Commercial |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$92.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$96.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.49
|
| Rate for Payer: PHP Commercial |
$91.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: Priority Health SBD |
$67.81
|
| Rate for Payer: UMR Bronson Commercial |
$47.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.72
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$107.63
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$96.87 |
| Rate for Payer: Aetna American Axle |
$69.96
|
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna Medicare |
$53.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.96
|
| Rate for Payer: BCBS Complete |
$43.05
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cofinity Commercial |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$92.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$96.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.49
|
| Rate for Payer: PHP Commercial |
$91.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: Priority Health SBD |
$67.81
|
| Rate for Payer: UMR Bronson Commercial |
$39.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.72
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$200.29
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$180.26 |
| Rate for Payer: Aetna American Axle |
$130.19
|
| Rate for Payer: Aetna American Axle |
$193.13
|
| Rate for Payer: Aetna Commercial |
$170.25
|
| Rate for Payer: Aetna Commercial |
$252.56
|
| Rate for Payer: Aetna Medicare |
$100.14
|
| Rate for Payer: Aetna Medicare |
$148.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.13
|
| Rate for Payer: BCBS Complete |
$118.85
|
| Rate for Payer: BCBS Complete |
$80.12
|
| Rate for Payer: Cash Price |
$160.23
|
| Rate for Payer: Cash Price |
$237.70
|
| Rate for Payer: Cofinity Commercial |
$172.25
|
| Rate for Payer: Cofinity Commercial |
$140.20
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.70
|
| Rate for Payer: Healthscope Commercial |
$267.42
|
| Rate for Payer: Healthscope Commercial |
$180.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.56
|
| Rate for Payer: PHP Commercial |
$252.56
|
| Rate for Payer: PHP Commercial |
$170.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.13
|
| Rate for Payer: Priority Health SBD |
$187.19
|
| Rate for Payer: Priority Health SBD |
$126.18
|
| Rate for Payer: UMR Bronson Commercial |
$74.11
|
| Rate for Payer: UMR Bronson Commercial |
$109.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.22
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$297.13
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.74 |
| Max. Negotiated Rate |
$267.42 |
| Rate for Payer: Aetna American Axle |
$193.13
|
| Rate for Payer: Aetna American Axle |
$130.19
|
| Rate for Payer: Aetna Commercial |
$170.25
|
| Rate for Payer: Aetna Commercial |
$252.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.13
|
| Rate for Payer: Cash Price |
$160.23
|
| Rate for Payer: Cash Price |
$237.70
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Cofinity Commercial |
$172.25
|
| Rate for Payer: Cofinity Commercial |
$140.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.70
|
| Rate for Payer: Healthscope Commercial |
$180.26
|
| Rate for Payer: Healthscope Commercial |
$267.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.56
|
| Rate for Payer: PHP Commercial |
$252.56
|
| Rate for Payer: PHP Commercial |
$170.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.13
|
| Rate for Payer: Priority Health SBD |
$187.19
|
| Rate for Payer: Priority Health SBD |
$126.18
|
| Rate for Payer: UMR Bronson Commercial |
$88.13
|
| Rate for Payer: UMR Bronson Commercial |
$130.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.85
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$298.38
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Aetna American Axle |
$193.95
|
| Rate for Payer: Aetna Commercial |
$253.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.95
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.87
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.62
|
| Rate for Payer: PHP Commercial |
$253.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.95
|
| Rate for Payer: Priority Health SBD |
$187.98
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$298.38
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Aetna American Axle |
$193.95
|
| Rate for Payer: Aetna Commercial |
$253.62
|
| Rate for Payer: Aetna Medicare |
$149.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.95
|
| Rate for Payer: BCBS Complete |
$119.35
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.87
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.62
|
| Rate for Payer: PHP Commercial |
$253.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.95
|
| Rate for Payer: Priority Health SBD |
$187.98
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$324.11
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.61 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Aetna American Axle |
$210.67
|
| Rate for Payer: Aetna Commercial |
$275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.67
|
| Rate for Payer: Cash Price |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$226.88
|
| Rate for Payer: Cofinity Commercial |
$278.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.29
|
| Rate for Payer: Healthscope Commercial |
$291.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.49
|
| Rate for Payer: PHP Commercial |
$275.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.67
|
| Rate for Payer: Priority Health SBD |
$204.19
|
| Rate for Payer: UMR Bronson Commercial |
$142.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.08
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$324.11
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Aetna American Axle |
$210.67
|
| Rate for Payer: Aetna Commercial |
$275.49
|
| Rate for Payer: Aetna Medicare |
$162.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.67
|
| Rate for Payer: BCBS Complete |
$129.64
|
| Rate for Payer: Cash Price |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$226.88
|
| Rate for Payer: Cofinity Commercial |
$278.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.29
|
| Rate for Payer: Healthscope Commercial |
$291.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.49
|
| Rate for Payer: PHP Commercial |
$275.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.67
|
| Rate for Payer: Priority Health SBD |
$204.19
|
| Rate for Payer: UMR Bronson Commercial |
$119.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.08
|
|
|
VIT A 5,000 UNIT-VIT C 60 MG-VIT E 30 UNIT-ZINC-SELENATE-COPPER TABLET
|
Facility
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 00904773518
|
| Hospital Charge Code |
173055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
VIT A 5,000 UNIT-VIT C 60 MG-VIT E 30 UNIT-ZINC-SELENATE-COPPER TABLET
|
Facility
|
OP
|
$81.78
|
|
|
Service Code
|
NDC 00904773518
|
| Hospital Charge Code |
173055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna Medicare |
$40.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: BCBS Complete |
$32.71
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna American Axle |
$10.24
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.24
|
| Rate for Payer: Priority Health SBD |
$9.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.81
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
NDC 61924020504
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna American Axle |
$10.24
|
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.39
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.24
|
| Rate for Payer: Priority Health SBD |
$9.92
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.81
|
|
|
VITAMIN A 2,400 MCG CAPSULE
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 54629011001
|
| Hospital Charge Code |
8641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
VITAMIN A 2,400 MCG CAPSULE
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 54629011001
|
| Hospital Charge Code |
8641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
NDC 00904208560
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna American Axle |
$98.80
|
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$130.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.60
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.20
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.80
|
| Rate for Payer: Priority Health SBD |
$95.76
|
| Rate for Payer: UMR Bronson Commercial |
$66.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.00
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
NDC 07610043310
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.68 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UMR Bronson Commercial |
$60.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
NDC 00904208560
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.24 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna American Axle |
$98.80
|
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$76.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.80
|
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$130.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.60
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.20
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.80
|
| Rate for Payer: Priority Health SBD |
$95.76
|
| Rate for Payer: UMR Bronson Commercial |
$56.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.00
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 07610043310
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UMR Bronson Commercial |
$72.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$42.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 00536141501
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 60258016001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 00536141501
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
