|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.95
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.93
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$70.50
|
|
|
Service Code
|
NDC 65862-528-30
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$296.40
|
|
|
Service Code
|
NDC 0904-6469-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.73 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.66
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$186.73
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$209.39
|
|
|
Service Code
|
NDC 65862-528-90
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.92 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Aetna Commercial |
$177.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cofinity Commercial |
$146.57
|
| Rate for Payer: Cofinity Commercial |
$180.08
|
| Rate for Payer: Healthscope Commercial |
$188.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.98
|
| Rate for Payer: PHP Commercial |
$177.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.57
|
| Rate for Payer: Priority Health SBD |
$131.92
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$226.58
|
|
|
Service Code
|
NDC 0093-7385-98
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Healthscope Commercial |
$203.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.59
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.61
|
| Rate for Payer: Priority Health SBD |
$142.75
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097-142-60
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.84
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.28
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$66.78
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.76
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health SBD |
$42.07
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$102.90
|
|
|
Service Code
|
NDC 66993-019-68
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.88
|
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Cofinity Commercial |
$72.03
|
| Rate for Payer: Cofinity Commercial |
$88.49
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.46
|
| Rate for Payer: PHP Commercial |
$87.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.03
|
| Rate for Payer: Priority Health SBD |
$64.83
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$174.30
|
|
|
Service Code
|
NDC 0173-0682-20
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Aetna Commercial |
$148.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.30
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Commercial |
$122.01
|
| Rate for Payer: Cofinity Commercial |
$149.90
|
| Rate for Payer: Healthscope Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.16
|
| Rate for Payer: PHP Commercial |
$148.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.01
|
| Rate for Payer: Priority Health SBD |
$109.81
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
IP
|
$37,325.91
|
|
|
Service Code
|
MS-DRG 032
|
| Min. Negotiated Rate |
$15,203.75 |
| Max. Negotiated Rate |
$37,325.91 |
| Rate for Payer: Aetna Medicare |
$16,644.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,004.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,004.94
|
| Rate for Payer: BCBS MAPPO |
$16,003.95
|
| Rate for Payer: BCBS Trust/PPO |
$37,325.91
|
| Rate for Payer: BCN Medicare Advantage |
$16,003.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,003.95
|
| Rate for Payer: Mclaren Medicare |
$16,003.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,804.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,404.54
|
| Rate for Payer: PACE Medicare |
$15,203.75
|
| Rate for Payer: PACE SWMI |
$16,003.95
|
| Rate for Payer: PHP Medicare Advantage |
$16,003.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,906.86
|
| Rate for Payer: Priority Health Medicare |
$16,003.95
|
| Rate for Payer: Priority Health Narrow Network |
$24,725.49
|
| Rate for Payer: Railroad Medicare Medicare |
$16,003.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,854.07
|
| Rate for Payer: UHC Core |
$20,159.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,003.95
|
| Rate for Payer: UHC Exchange |
$21,591.85
|
| Rate for Payer: UHC Medicare Advantage |
$16,484.07
|
| Rate for Payer: VA VA |
$16,003.95
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
IP
|
$87,001.56
|
|
|
Service Code
|
MS-DRG 031
|
| Min. Negotiated Rate |
$28,632.65 |
| Max. Negotiated Rate |
$87,001.56 |
| Rate for Payer: Aetna Medicare |
$31,345.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,674.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,674.54
|
| Rate for Payer: BCBS MAPPO |
$30,139.63
|
| Rate for Payer: BCBS Trust/PPO |
$87,001.56
|
| Rate for Payer: BCN Medicare Advantage |
$30,139.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,139.63
|
| Rate for Payer: Mclaren Medicare |
$30,139.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,646.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,660.57
|
| Rate for Payer: PACE Medicare |
$28,632.65
|
| Rate for Payer: PACE SWMI |
$30,139.63
|
| Rate for Payer: PHP Medicare Advantage |
$30,139.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59,072.88
|
| Rate for Payer: Priority Health Medicare |
$30,139.63
|
| Rate for Payer: Priority Health Narrow Network |
$47,258.30
|
| Rate for Payer: Railroad Medicare Medicare |
$30,139.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,794.62
|
| Rate for Payer: UHC Core |
$38,531.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,139.63
|
| Rate for Payer: UHC Exchange |
$41,268.92
|
| Rate for Payer: UHC Medicare Advantage |
$31,043.82
|
| Rate for Payer: VA VA |
$30,139.63
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,128.68
|
|
|
Service Code
|
MS-DRG 033
|
| Min. Negotiated Rate |
$11,571.48 |
| Max. Negotiated Rate |
$34,128.68 |
| Rate for Payer: Aetna Medicare |
$12,667.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,225.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,225.62
|
| Rate for Payer: BCBS MAPPO |
$12,180.50
|
| Rate for Payer: BCBS Trust/PPO |
$34,128.68
|
| Rate for Payer: BCN Medicare Advantage |
$12,180.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,180.50
|
| Rate for Payer: Mclaren Medicare |
$12,180.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,789.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,007.58
|
| Rate for Payer: PACE Medicare |
$11,571.48
|
| Rate for Payer: PACE SWMI |
$12,180.50
|
| Rate for Payer: PHP Medicare Advantage |
$12,180.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,288.49
|
| Rate for Payer: Priority Health Medicare |
$12,180.50
|
| Rate for Payer: Priority Health Narrow Network |
$18,630.79
|
| Rate for Payer: Railroad Medicare Medicare |
$12,180.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,755.72
|
| Rate for Payer: UHC Core |
$15,190.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,180.50
|
| Rate for Payer: UHC Exchange |
$16,269.57
|
| Rate for Payer: UHC Medicare Advantage |
$12,545.92
|
| Rate for Payer: VA VA |
$12,180.50
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$113.40
|
|
|
Service Code
|
NDC 0409-1144-05
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.39
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.38
|
| Rate for Payer: Priority Health SBD |
$71.44
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.23
|
|
|
Service Code
|
NDC 0409-1144-02
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$20.91 |
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.10
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$20.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.75
|
| Rate for Payer: PHP Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.26
|
| Rate for Payer: Priority Health SBD |
$14.63
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$21.66
|
|
|
Service Code
|
NDC 70756-605-82
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.41
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health SBD |
$13.65
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$21.48
|
|
|
Service Code
|
NDC 70756-605-25
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.26
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$13.53
|
|
|
VERAPAMIL 40 MG TABLET
|
Facility
IP
|
$345.45
|
|
|
Service Code
|
NDC 0591-0404-01
|
| Hospital Charge Code |
8529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.63 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: Priority Health SBD |
$217.63
|
|
|
VERAPAMIL 40 MG TABLET
|
Facility
IP
|
$303.15
|
|
|
Service Code
|
NDC 23155-059-01
|
| Hospital Charge Code |
8529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.98 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.20
|
| Rate for Payer: Priority Health SBD |
$190.98
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$194.75
|
|
|
Service Code
|
NDC 68462-292-01
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.48
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.54
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
| Rate for Payer: Priority Health SBD |
$122.69
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$524.64
|
|
|
Service Code
|
NDC 60687-493-01
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.52 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.02
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Cofinity Commercial |
$451.19
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.94
|
| Rate for Payer: PHP Commercial |
$445.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health SBD |
$330.52
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$5.25
|
|
|
Service Code
|
NDC 60687-493-11
|
| 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 Commercial |
$3.68
|
| Rate for Payer: Cofinity Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: PHP Commercial |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: Priority Health SBD |
$3.31
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$2,108.26
|
|
|
Service Code
|
NDC 0025-1901-31
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,328.20 |
| Max. Negotiated Rate |
$1,897.43 |
| Rate for Payer: Aetna Commercial |
$1,792.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,370.37
|
| Rate for Payer: Cash Price |
$1,686.61
|
| Rate for Payer: Cofinity Commercial |
$1,475.78
|
| Rate for Payer: Cofinity Commercial |
$1,813.10
|
| Rate for Payer: Healthscope Commercial |
$1,897.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,792.02
|
| Rate for Payer: PHP Commercial |
$1,792.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.78
|
| Rate for Payer: Priority Health SBD |
$1,328.20
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$5.62
|
|
|
Service Code
|
NDC 60687-504-11
|
| 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 Commercial |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.78
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health SBD |
$3.54
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$561.60
|
|
|
Service Code
|
NDC 60687-504-01
|
| 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 Commercial |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$482.98
|
| Rate for Payer: Healthscope Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.36
|
| Rate for Payer: PHP Commercial |
$477.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health SBD |
$353.81
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$978.50
|
|
|
Service Code
|
NDC 68462-293-05
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.46 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Aetna Commercial |
$831.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.02
|
| Rate for Payer: Cash Price |
$782.80
|
| Rate for Payer: Cofinity Commercial |
$684.95
|
| Rate for Payer: Cofinity Commercial |
$841.51
|
| Rate for Payer: Healthscope Commercial |
$880.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$831.72
|
| Rate for Payer: PHP Commercial |
$831.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.95
|
| Rate for Payer: Priority Health SBD |
$616.46
|
|
