|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Advantage |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.90
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.38
|
| Rate for Payer: UHC Core |
$106.91
|
| Rate for Payer: UHC Exchange |
$80.64
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.28 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Advantage |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.90
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health SBD |
$129.28
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.18 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna Medicare |
$262.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.02
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Advantage |
$367.25
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.48
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: Priority Health SBD |
$330.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.02
|
| Rate for Payer: UHC Core |
$273.34
|
| Rate for Payer: UHC Exchange |
$206.18
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.46
|
| Rate for Payer: Aetna Medicare |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.41
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Advantage |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.94
|
| Rate for Payer: PHP Commercial |
$4.46
|
| Rate for Payer: Priority Health SBD |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$2.74
|
| Rate for Payer: UHC Exchange |
$2.06
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.41
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Advantage |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.94
|
| Rate for Payer: PHP Commercial |
$4.46
|
| Rate for Payer: Priority Health SBD |
$3.31
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$213.75
|
|
|
Service Code
|
NDC 75834015801
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$192.38 |
| Rate for Payer: Aetna Commercial |
$181.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.94
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Advantage |
$149.62
|
| Rate for Payer: Cofinity Commercial |
$183.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: PHP Commercial |
$181.69
|
| Rate for Payer: Priority Health SBD |
$134.66
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2,009.25
|
|
|
Service Code
|
NDC 68462029305
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$789.64 |
| Max. Negotiated Rate |
$1,808.33 |
| Rate for Payer: Aetna Commercial |
$1,707.86
|
| Rate for Payer: Aetna Medicare |
$1,004.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.01
|
| Rate for Payer: BCBS Complete |
$803.70
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cofinity Advantage |
$1,406.47
|
| Rate for Payer: Cofinity Commercial |
$1,727.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.40
|
| Rate for Payer: Healthscope Commercial |
$1,808.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,607.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.94
|
| Rate for Payer: PHP Commercial |
$1,707.86
|
| Rate for Payer: Priority Health SBD |
$1,265.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.01
|
| Rate for Payer: UHC Core |
$1,046.82
|
| Rate for Payer: UHC Exchange |
$789.64
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna Commercial |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health SBD |
$3.54
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Advantage |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.59
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health SBD |
$276.85
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$213.75
|
|
|
Service Code
|
NDC 75834015801
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$192.38 |
| Rate for Payer: Aetna Commercial |
$181.69
|
| Rate for Payer: Aetna Medicare |
$106.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.94
|
| Rate for Payer: BCBS Complete |
$85.50
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Advantage |
$149.62
|
| Rate for Payer: Cofinity Commercial |
$183.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$192.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: PHP Commercial |
$181.69
|
| Rate for Payer: Priority Health SBD |
$134.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.94
|
| Rate for Payer: UHC Core |
$111.36
|
| Rate for Payer: UHC Exchange |
$84.00
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2,009.25
|
|
|
Service Code
|
NDC 68462029305
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,265.83 |
| Max. Negotiated Rate |
$1,808.33 |
| Rate for Payer: Aetna Commercial |
$1,707.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.01
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cofinity Advantage |
$1,406.47
|
| Rate for Payer: Cofinity Commercial |
$1,727.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.40
|
| Rate for Payer: Healthscope Commercial |
$1,808.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.94
|
| Rate for Payer: PHP Commercial |
$1,707.86
|
| Rate for Payer: Priority Health SBD |
$1,265.83
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.81 |
| Max. Negotiated Rate |
$505.44 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.04
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Advantage |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$482.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.20
|
| Rate for Payer: PHP Commercial |
$477.36
|
| Rate for Payer: Priority Health SBD |
$353.81
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.70 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna Medicare |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: BCBS Complete |
$175.78
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Advantage |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.59
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.64
|
| Rate for Payer: UHC Core |
$228.95
|
| Rate for Payer: UHC Exchange |
$172.70
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna Commercial |
$4.78
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health SBD |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$2.93
|
| Rate for Payer: UHC Exchange |
$2.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.71 |
| Max. Negotiated Rate |
$505.44 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Medicare |
$280.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.04
|
| Rate for Payer: BCBS Complete |
$224.64
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Advantage |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$482.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$505.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.20
|
| Rate for Payer: PHP Commercial |
$477.36
|
| Rate for Payer: Priority Health SBD |
$353.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.04
|
| Rate for Payer: UHC Core |
$292.59
|
| Rate for Payer: UHC Exchange |
$220.71
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$28,192.60
|
|
|
Service Code
|
APR-DRG 3104
|
| Min. Negotiated Rate |
$26,850.10 |
| Max. Negotiated Rate |
$28,192.60 |
| Rate for Payer: UHC Medicaid |
$26,850.10
|
| Rate for Payer: BCBS Complete |
$28,192.60
|
| Rate for Payer: Mclaren Medicaid |
$26,850.10
|
| Rate for Payer: Meridian Medicaid |
$28,192.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,850.10
|
| Rate for Payer: UHCCP Medicaid |
$26,850.10
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$12,921.61
|
|
|
Service Code
|
APR-DRG 3102
|
| Min. Negotiated Rate |
$12,306.29 |
| Max. Negotiated Rate |
$12,921.61 |
| Rate for Payer: BCBS Complete |
$12,921.61
|
| Rate for Payer: Mclaren Medicaid |
$12,306.29
|
| Rate for Payer: Meridian Medicaid |
$12,921.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,306.29
|
| Rate for Payer: UHC Medicaid |
$12,306.29
|
| Rate for Payer: UHCCP Medicaid |
$12,306.29
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$8,641.35
|
|
|
Service Code
|
APR-DRG 3101
|
| Min. Negotiated Rate |
$8,229.86 |
| Max. Negotiated Rate |
$8,641.35 |
| Rate for Payer: BCBS Complete |
$8,641.35
|
| Rate for Payer: Mclaren Medicaid |
$8,229.86
|
| Rate for Payer: Meridian Medicaid |
$8,641.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,229.86
|
| Rate for Payer: UHC Medicaid |
$8,229.86
|
| Rate for Payer: UHCCP Medicaid |
$8,229.86
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$20,518.41
|
|
|
Service Code
|
APR-DRG 3103
|
| Min. Negotiated Rate |
$19,541.34 |
| Max. Negotiated Rate |
$20,518.41 |
| Rate for Payer: BCBS Complete |
$20,518.41
|
| Rate for Payer: Mclaren Medicaid |
$19,541.34
|
| Rate for Payer: Meridian Medicaid |
$20,518.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,541.34
|
| Rate for Payer: UHC Medicaid |
$19,541.34
|
| Rate for Payer: UHCCP Medicaid |
$19,541.34
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$8,958.96
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$8,532.34 |
| Max. Negotiated Rate |
$8,958.96 |
| Rate for Payer: BCBS Complete |
$8,958.96
|
| Rate for Payer: Mclaren Medicaid |
$8,532.34
|
| Rate for Payer: Meridian Medicaid |
$8,958.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,532.34
|
| Rate for Payer: UHC Medicaid |
$8,532.34
|
| Rate for Payer: UHCCP Medicaid |
$8,532.34
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$4,151.84
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$3,954.13 |
| Max. Negotiated Rate |
$4,151.84 |
| Rate for Payer: BCBS Complete |
$4,151.84
|
| Rate for Payer: Mclaren Medicaid |
$3,954.13
|
| Rate for Payer: Meridian Medicaid |
$4,151.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,954.13
|
| Rate for Payer: UHC Medicaid |
$3,954.13
|
| Rate for Payer: UHCCP Medicaid |
$3,954.13
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$4,795.65
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$4,567.29 |
| Max. Negotiated Rate |
$4,795.65 |
| Rate for Payer: BCBS Complete |
$4,795.65
|
| Rate for Payer: Mclaren Medicaid |
$4,567.29
|
| Rate for Payer: Meridian Medicaid |
$4,795.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,567.29
|
| Rate for Payer: UHC Medicaid |
$4,567.29
|
| Rate for Payer: UHCCP Medicaid |
$4,567.29
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$5,956.59
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$5,672.94 |
| Max. Negotiated Rate |
$5,956.59 |
| Rate for Payer: BCBS Complete |
$5,956.59
|
| Rate for Payer: Mclaren Medicaid |
$5,672.94
|
| Rate for Payer: Meridian Medicaid |
$5,956.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,672.94
|
| Rate for Payer: UHC Medicaid |
$5,672.94
|
| Rate for Payer: UHCCP Medicaid |
$5,672.94
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$1,317.46
|
|
|
Service Code
|
NDC 00456112030
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$517.76 |
| Max. Negotiated Rate |
$1,185.71 |
| Rate for Payer: Aetna Commercial |
$1,119.84
|
| Rate for Payer: Aetna Medicare |
$658.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.35
|
| Rate for Payer: BCBS Complete |
$526.98
|
| Rate for Payer: Cash Price |
$1,053.97
|
| Rate for Payer: Cofinity Advantage |
$922.22
|
| Rate for Payer: Cofinity Commercial |
$1,133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.97
|
| Rate for Payer: Healthscope Commercial |
$1,185.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,053.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$988.10
|
| Rate for Payer: PHP Commercial |
$1,119.84
|
| Rate for Payer: Priority Health SBD |
$830.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.35
|
| Rate for Payer: UHC Core |
$686.40
|
| Rate for Payer: UHC Exchange |
$517.76
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$542.24
|
|
|
Service Code
|
NDC 62332023330
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.10 |
| Max. Negotiated Rate |
$488.02 |
| Rate for Payer: Aetna Commercial |
$460.90
|
| Rate for Payer: Aetna Medicare |
$271.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.46
|
| Rate for Payer: BCBS Complete |
$216.90
|
| Rate for Payer: Cash Price |
$433.79
|
| Rate for Payer: Cofinity Advantage |
$379.57
|
| Rate for Payer: Cofinity Commercial |
$466.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.79
|
| Rate for Payer: Healthscope Commercial |
$488.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.68
|
| Rate for Payer: PHP Commercial |
$460.90
|
| Rate for Payer: Priority Health SBD |
$341.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.46
|
| Rate for Payer: UHC Core |
$282.51
|
| Rate for Payer: UHC Exchange |
$213.10
|
|