|
VIVONEX RTF BOLUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna American Axle |
$6.01
|
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.01
|
| Rate for Payer: BCBS Complete |
$3.70
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.01
|
| Rate for Payer: Priority Health SBD |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 09900000576
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna American Axle |
$6.01
|
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.01
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.86
|
| Rate for Payer: PHP Commercial |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.01
|
| Rate for Payer: Priority Health SBD |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$4.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.94
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF CYCLIC FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VIVONEX RTF INTERMITTENT FEED
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 43900036250
|
| Hospital Charge Code |
200088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$1,600.07
|
|
|
Service Code
|
NDC 00049316044
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$704.03 |
| Max. Negotiated Rate |
$1,440.06 |
| Rate for Payer: Aetna American Axle |
$1,040.05
|
| Rate for Payer: Aetna Commercial |
$1,360.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.05
|
| Rate for Payer: Cash Price |
$1,280.06
|
| Rate for Payer: Cofinity Commercial |
$1,120.05
|
| Rate for Payer: Cofinity Commercial |
$1,376.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.06
|
| Rate for Payer: Healthscope Commercial |
$1,440.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,120.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,200.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,360.06
|
| Rate for Payer: PHP Commercial |
$1,360.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,040.05
|
| Rate for Payer: Priority Health SBD |
$1,008.04
|
| Rate for Payer: UMR Bronson Commercial |
$704.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,200.05
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,751.14
|
|
|
Service Code
|
NDC 65162091322
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,210.50 |
| Max. Negotiated Rate |
$2,476.03 |
| Rate for Payer: Aetna American Axle |
$1,788.24
|
| Rate for Payer: Aetna Commercial |
$2,338.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,788.24
|
| Rate for Payer: Cash Price |
$2,200.91
|
| Rate for Payer: Cofinity Commercial |
$1,925.80
|
| Rate for Payer: Cofinity Commercial |
$2,365.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,925.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.91
|
| Rate for Payer: Healthscope Commercial |
$2,476.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,925.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,063.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,338.47
|
| Rate for Payer: PHP Commercial |
$2,338.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,788.24
|
| Rate for Payer: Priority Health SBD |
$1,733.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,063.36
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,751.14
|
|
|
Service Code
|
NDC 65162091322
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,017.92 |
| Max. Negotiated Rate |
$2,476.03 |
| Rate for Payer: Aetna American Axle |
$1,788.24
|
| Rate for Payer: Aetna Commercial |
$2,338.47
|
| Rate for Payer: Aetna Medicare |
$1,375.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,788.24
|
| Rate for Payer: BCBS Complete |
$1,100.46
|
| Rate for Payer: Cash Price |
$2,200.91
|
| Rate for Payer: Cofinity Commercial |
$1,925.80
|
| Rate for Payer: Cofinity Commercial |
$2,365.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,925.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.91
|
| Rate for Payer: Healthscope Commercial |
$2,476.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,925.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,063.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,338.47
|
| Rate for Payer: PHP Commercial |
$2,338.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,788.24
|
| Rate for Payer: Priority Health SBD |
$1,733.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,063.36
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,404.26
|
|
|
Service Code
|
NDC 43386003860
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$889.58 |
| Max. Negotiated Rate |
$2,163.83 |
| Rate for Payer: Aetna American Axle |
$1,562.77
|
| Rate for Payer: Aetna Commercial |
$2,043.62
|
| Rate for Payer: Aetna Medicare |
$1,202.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,562.77
|
| Rate for Payer: BCBS Complete |
$961.70
|
| Rate for Payer: Cash Price |
$1,923.41
|
| Rate for Payer: Cofinity Commercial |
$1,682.98
|
| Rate for Payer: Cofinity Commercial |
$2,067.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,682.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,923.41
|
| Rate for Payer: Healthscope Commercial |
$2,163.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,682.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,803.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,043.62
|
| Rate for Payer: PHP Commercial |
$2,043.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.77
|
| Rate for Payer: Priority Health SBD |
$1,514.68
|
| Rate for Payer: UMR Bronson Commercial |
$889.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,803.20
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$1,600.07
|
|
|
Service Code
|
NDC 00049316044
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$592.03 |
| Max. Negotiated Rate |
$1,440.06 |
| Rate for Payer: Aetna American Axle |
$1,040.05
|
| Rate for Payer: Aetna Commercial |
$1,360.06
|
| Rate for Payer: Aetna Medicare |
$800.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.05
|
| Rate for Payer: BCBS Complete |
$640.03
|
| Rate for Payer: Cash Price |
$1,280.06
|
| Rate for Payer: Cofinity Commercial |
$1,120.05
|
| Rate for Payer: Cofinity Commercial |
$1,376.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.06
|
| Rate for Payer: Healthscope Commercial |
$1,440.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,120.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,200.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,360.06
|
| Rate for Payer: PHP Commercial |
$1,360.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,040.05
|
| Rate for Payer: Priority Health SBD |
$1,008.04
|
| Rate for Payer: UMR Bronson Commercial |
$592.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,200.05
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,404.26
|
|
|
Service Code
|
NDC 43386003860
|
| Hospital Charge Code |
38103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,057.87 |
| Max. Negotiated Rate |
$2,163.83 |
| Rate for Payer: Aetna American Axle |
$1,562.77
|
| Rate for Payer: Aetna Commercial |
$2,043.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,562.77
|
| Rate for Payer: Cash Price |
$1,923.41
|
| Rate for Payer: Cofinity Commercial |
$1,682.98
|
| Rate for Payer: Cofinity Commercial |
$2,067.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,682.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,923.41
|
| Rate for Payer: Healthscope Commercial |
$2,163.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,682.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,803.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,043.62
|
| Rate for Payer: PHP Commercial |
$2,043.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.77
|
| Rate for Payer: Priority Health SBD |
$1,514.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,803.20
|
|
|
VORICONAZOLE 200 MG INHALATION SOLUTION
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
180485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UMR Bronson Commercial |
$41.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
VORICONAZOLE 200 MG INHALATION SOLUTION
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
180485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UMR Bronson Commercial |
$48.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$70.45
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna American Axle |
$34.98
|
| Rate for Payer: Aetna American Axle |
$107.60
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$41.77
|
| Rate for Payer: Aetna American Axle |
$42.67
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna Commercial |
$55.79
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$35.22
|
| Rate for Payer: Aetna Medicare |
$32.13
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Aetna Medicare |
$32.82
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: BCBS Complete |
$26.26
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$45.95
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$55.79
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.98
|
| Rate for Payer: Priority Health SBD |
$41.35
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: UMR Bronson Commercial |
$24.29
|
| Rate for Payer: UMR Bronson Commercial |
$26.07
|
| Rate for Payer: UMR Bronson Commercial |
$21.69
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: UMR Bronson Commercial |
$19.91
|
| Rate for Payer: UMR Bronson Commercial |
$23.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$165.54
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
33010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Aetna American Axle |
$107.60
|
| Rate for Payer: Aetna American Axle |
$42.67
|
| Rate for Payer: Aetna American Axle |
$41.77
|
| Rate for Payer: Aetna American Axle |
$34.98
|
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna American Axle |
$45.79
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$55.79
|
| Rate for Payer: Aetna Commercial |
$49.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$46.89
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cofinity Commercial |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$45.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.36
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Commercial |
$55.79
|
| Rate for Payer: PHP Commercial |
$49.82
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health SBD |
$41.35
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: UMR Bronson Commercial |
$31.00
|
| Rate for Payer: UMR Bronson Commercial |
$23.68
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.88
|
| Rate for Payer: UMR Bronson Commercial |
$28.27
|
| Rate for Payer: UMR Bronson Commercial |
$72.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.16
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$169.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$212.69
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.70 |
| Max. Negotiated Rate |
$191.42 |
| Rate for Payer: Aetna American Axle |
$138.25
|
| Rate for Payer: Aetna Commercial |
$180.79
|
| Rate for Payer: Aetna Medicare |
$106.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.25
|
| Rate for Payer: BCBS Complete |
$85.08
|
| Rate for Payer: Cash Price |
$170.15
|
| Rate for Payer: Cofinity Commercial |
$148.88
|
| Rate for Payer: Cofinity Commercial |
$182.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.15
|
| Rate for Payer: Healthscope Commercial |
$191.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.79
|
| Rate for Payer: PHP Commercial |
$180.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.25
|
| Rate for Payer: Priority Health SBD |
$133.99
|
| Rate for Payer: UMR Bronson Commercial |
$78.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.52
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 00049318030
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna American Axle |
$250.51
|
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.05
|
|
|
VORICONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$212.69
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
33009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$191.42 |
| Rate for Payer: Aetna American Axle |
$138.25
|
| Rate for Payer: Aetna Commercial |
$180.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.25
|
| Rate for Payer: Cash Price |
$170.15
|
| Rate for Payer: Cofinity Commercial |
$148.88
|
| Rate for Payer: Cofinity Commercial |
$182.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.15
|
| Rate for Payer: Healthscope Commercial |
$191.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.79
|
| Rate for Payer: PHP Commercial |
$180.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.25
|
| Rate for Payer: Priority Health SBD |
$133.99
|
| Rate for Payer: UMR Bronson Commercial |
$93.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.52
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
OP
|
$966.59
|
|
|
Service Code
|
NDC 00378162693
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.64 |
| Max. Negotiated Rate |
$869.93 |
| Rate for Payer: Aetna American Axle |
$628.28
|
| Rate for Payer: Aetna Commercial |
$821.60
|
| Rate for Payer: Aetna Medicare |
$483.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.28
|
| Rate for Payer: BCBS Complete |
$386.64
|
| Rate for Payer: Cash Price |
$773.27
|
| Rate for Payer: Cofinity Commercial |
$676.61
|
| Rate for Payer: Cofinity Commercial |
$831.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$676.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.27
|
| Rate for Payer: Healthscope Commercial |
$869.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.60
|
| Rate for Payer: PHP Commercial |
$821.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.28
|
| Rate for Payer: Priority Health SBD |
$608.95
|
| Rate for Payer: UMR Bronson Commercial |
$357.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.94
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
IP
|
$199.88
|
|
|
Service Code
|
NDC 00049317030
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.95 |
| Max. Negotiated Rate |
$179.89 |
| Rate for Payer: Aetna American Axle |
$129.92
|
| Rate for Payer: Aetna Commercial |
$169.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.92
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cofinity Commercial |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$171.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.90
|
| Rate for Payer: Healthscope Commercial |
$179.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.90
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.92
|
| Rate for Payer: Priority Health SBD |
$125.92
|
| Rate for Payer: UMR Bronson Commercial |
$87.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.91
|
|
