|
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
|
|
|
VORICONAZOLE 50 MG TABLET
|
Facility
|
IP
|
$966.59
|
|
|
Service Code
|
NDC 00378162693
|
| Hospital Charge Code |
33008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.30 |
| Max. Negotiated Rate |
$869.93 |
| Rate for Payer: Cash Price |
$773.27
|
| Rate for Payer: Aetna American Axle |
$628.28
|
| Rate for Payer: Aetna Commercial |
$821.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.28
|
| Rate for Payer: 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 |
$425.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.94
|
|
|
VORINOSTAT 100 MG CAPSULE
|
Facility
|
IP
|
$55,535.52
|
|
|
Service Code
|
NDC 00006056840
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24,435.63 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Commercial |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,874.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,205.19
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,098.09
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UMR Bronson Commercial |
$24,435.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORINOSTAT 100 MG CAPSULE
|
Facility
|
OP
|
$55,535.52
|
|
|
Service Code
|
NDC 00006056840
|
| Hospital Charge Code |
77539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20,548.14 |
| Max. Negotiated Rate |
$49,981.97 |
| Rate for Payer: Aetna American Axle |
$36,098.09
|
| Rate for Payer: Aetna Commercial |
$47,205.19
|
| Rate for Payer: Aetna Medicare |
$27,767.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,098.09
|
| Rate for Payer: BCBS Complete |
$22,214.21
|
| Rate for Payer: Cash Price |
$44,428.42
|
| Rate for Payer: Cofinity Commercial |
$38,874.86
|
| Rate for Payer: Cofinity Commercial |
$47,760.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$38,874.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,428.42
|
| Rate for Payer: Healthscope Commercial |
$49,981.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38,874.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,651.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,205.19
|
| Rate for Payer: PHP Commercial |
$47,205.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,098.09
|
| Rate for Payer: Priority Health SBD |
$34,987.38
|
| Rate for Payer: UMR Bronson Commercial |
$20,548.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,651.64
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
OP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna American Axle |
$1,150.00
|
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna Medicare |
$884.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.00
|
| Rate for Payer: BCBS Complete |
$707.69
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,238.46
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health SBD |
$1,114.61
|
| Rate for Payer: UMR Bronson Commercial |
$654.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VORTIOXETINE 10 MG TABLET
|
Facility
|
IP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764073030
|
| Hospital Charge Code |
168416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$778.46 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna American Axle |
$1,150.00
|
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,238.46
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health SBD |
$1,114.61
|
| Rate for Payer: UMR Bronson Commercial |
$778.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
IP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$778.46 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna American Axle |
$1,150.00
|
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,238.46
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health SBD |
$1,114.61
|
| Rate for Payer: UMR Bronson Commercial |
$778.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VORTIOXETINE 20 MG TABLET
|
Facility
|
OP
|
$1,769.23
|
|
|
Service Code
|
NDC 64764075030
|
| Hospital Charge Code |
168417
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$1,592.31 |
| Rate for Payer: Aetna American Axle |
$1,150.00
|
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna Medicare |
$884.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.00
|
| Rate for Payer: BCBS Complete |
$707.69
|
| Rate for Payer: Cash Price |
$1,415.38
|
| Rate for Payer: Cofinity Commercial |
$1,238.46
|
| Rate for Payer: Cofinity Commercial |
$1,521.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.38
|
| Rate for Payer: Healthscope Commercial |
$1,592.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.85
|
| Rate for Payer: PHP Commercial |
$1,503.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.00
|
| Rate for Payer: Priority Health SBD |
$1,114.61
|
| Rate for Payer: UMR Bronson Commercial |
$654.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.92
|
|
|
VULVECTOMY SIMPLE; COMPLETE
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$646.46 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,937.53
|
| Rate for Payer: BCN Commercial |
$1,937.53
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.11
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$646.46
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.11 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,266.78
|
| Rate for Payer: BCN Commercial |
$3,266.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.52
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$564.11
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00832121100
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 65162076110
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$177.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.65
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
OP
|
$371.30
|
|
|
Service Code
|
NDC 00832121101
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna Medicare |
$185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: BCBS Complete |
$148.52
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.34
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$137.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 00832121189
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00832121100
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 1 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 65162076110
|
| Hospital Charge Code |
11664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.36 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Commercial |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.65
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00832121389
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
NDC 68084002711
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna American Axle |
$142.02
|
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.02
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.02
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00093171401
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 68084002701
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna American Axle |
$142.02
|
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.02
|
| Rate for Payer: BCBS Complete |
$87.40
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.02
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UMR Bronson Commercial |
$80.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 00832121301
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UMR Bronson Commercial |
$136.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
WARFARIN 2.5 MG TABLET
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 68084002711
|
| Hospital Charge Code |
8750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna American Axle |
$142.02
|
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.02
|
| Rate for Payer: BCBS Complete |
$87.40
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.02
|
| Rate for Payer: Priority Health SBD |
$137.66
|
| Rate for Payer: UMR Bronson Commercial |
$80.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.88
|
|
