|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
IP
|
$267.43
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.67 |
| Max. Negotiated Rate |
$240.69 |
| Rate for Payer: Aetna American Axle |
$173.83
|
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.83
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Cofinity Commercial |
$187.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.32
|
| Rate for Payer: PHP Commercial |
$227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health SBD |
$168.48
|
| Rate for Payer: UMR Bronson Commercial |
$117.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.57
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$101.49
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$91.34 |
| Rate for Payer: Aetna American Axle |
$65.97
|
| Rate for Payer: Aetna American Axle |
$58.24
|
| Rate for Payer: Aetna American Axle |
$173.83
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$76.03
|
| Rate for Payer: Aetna American Axle |
$34.92
|
| Rate for Payer: Aetna American Axle |
$100.66
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna Commercial |
$86.27
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: Aetna Commercial |
$76.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.97
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$71.68
|
| Rate for Payer: Cash Price |
$81.19
|
| Rate for Payer: Cofinity Commercial |
$62.72
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$81.88
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$87.28
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Cofinity Commercial |
$77.06
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Healthscope Commercial |
$91.34
|
| Rate for Payer: Healthscope Commercial |
$105.27
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Healthscope Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.32
|
| Rate for Payer: PHP Commercial |
$227.32
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$76.16
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$86.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.04
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$168.48
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$73.69
|
| Rate for Payer: Priority Health SBD |
$63.94
|
| Rate for Payer: Priority Health SBD |
$56.45
|
| Rate for Payer: Priority Health SBD |
$61.53
|
| Rate for Payer: UMR Bronson Commercial |
$68.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.64
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: UMR Bronson Commercial |
$51.47
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: UMR Bronson Commercial |
$44.66
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: UMR Bronson Commercial |
$117.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.25
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.24
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.43
|
| 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 |
$16.27
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.43
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$18.32
|
|
|
Service Code
|
NDC 0409-1632-49
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Aetna American Axle |
$11.91
|
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$16.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.57
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$11.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.74
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$26.08
|
|
|
Service Code
|
NDC 0703-2914-03
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna American Axle |
$16.95
|
| Rate for Payer: Aetna Commercial |
$22.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.17
|
| Rate for Payer: PHP Commercial |
$22.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$16.43
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.56
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.55
|
|
|
Service Code
|
NDC 63323-781-21
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$29.26
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna American Axle |
$19.02
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.87
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.48
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$20.28
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna American Axle |
$13.18
|
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.69
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna American Axle |
$10.85
|
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.68
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.35
|
|
|
Service Code
|
NDC 0143-9234-01
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Aetna American Axle |
$18.43
|
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.43
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.68
|
| Rate for Payer: Healthscope Commercial |
$25.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.10
|
| Rate for Payer: PHP Commercial |
$24.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.84
|
| Rate for Payer: Priority Health SBD |
$17.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.26
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.55
|
|
|
Service Code
|
NDC 63323-781-10
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$35.94
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna American Axle |
$23.36
|
| Rate for Payer: Aetna Commercial |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.36
|
| Rate for Payer: Cash Price |
$28.75
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.75
|
| Rate for Payer: Healthscope Commercial |
$32.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.55
|
| Rate for Payer: PHP Commercial |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$22.64
|
| Rate for Payer: UMR Bronson Commercial |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.35
|
|
|
Service Code
|
NDC 0143-9234-10
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Aetna American Axle |
$18.43
|
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.43
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.68
|
| Rate for Payer: Healthscope Commercial |
$25.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.10
|
| Rate for Payer: PHP Commercial |
$24.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.84
|
| Rate for Payer: Priority Health SBD |
$17.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.26
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$25.57
|
|
|
Service Code
|
NDC 55390-037-10
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna American Axle |
$16.62
|
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.62
|
| Rate for Payer: Cash Price |
$20.46
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.46
|
| Rate for Payer: Healthscope Commercial |
$23.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.73
|
| Rate for Payer: PHP Commercial |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health SBD |
$16.11
|
| Rate for Payer: UMR Bronson Commercial |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.18
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$20.28
|
|
|
Service Code
|
NDC 67457-438-00
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna American Axle |
$13.18
|
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$26.08
|
|
|
Service Code
|
NDC 0703-2914-01
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna American Axle |
$16.95
|
| Rate for Payer: Aetna Commercial |
$22.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.17
|
| Rate for Payer: PHP Commercial |
$22.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$16.43
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.56
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.69
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna American Axle |
$10.85
|
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.68
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLUTION (CODE)
|
Facility
IP
|
$23.24
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
163723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.43
|
| 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 |
$16.27
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.43
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLUTION (CODE)
|
Facility
IP
|
$35.94
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
163723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna American Axle |
$23.36
|
| Rate for Payer: Aetna Commercial |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.36
|
| Rate for Payer: Cash Price |
$28.75
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.75
|
| Rate for Payer: Healthscope Commercial |
$32.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.55
|
| Rate for Payer: PHP Commercial |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$22.64
|
| Rate for Payer: UMR Bronson Commercial |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.96
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLUTION (CODE)
|
Facility
IP
|
$25.57
|
|
|
Service Code
|
NDC 55390-037-10
|
| Hospital Charge Code |
163723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna American Axle |
$16.62
|
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.62
|
| Rate for Payer: Cash Price |
$20.46
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.46
|
| Rate for Payer: Healthscope Commercial |
$23.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.73
|
| Rate for Payer: PHP Commercial |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health SBD |
$16.11
|
| Rate for Payer: UMR Bronson Commercial |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.18
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLUTION (CODE)
|
Facility
IP
|
$18.32
|
|
|
Service Code
|
NDC 0409-1632-49
|
| Hospital Charge Code |
163723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Aetna American Axle |
$11.91
|
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.91
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$12.82
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$16.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.57
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: Priority Health SBD |
$11.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.74
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$40.98
|
|
|
Service Code
|
NDC 67457-475-00
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna American Axle |
$26.64
|
| Rate for Payer: Aetna Commercial |
$34.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.64
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$28.69
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.83
|
| Rate for Payer: PHP Commercial |
$34.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.69
|
| Rate for Payer: Priority Health SBD |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$18.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$54.39
|
|
|
Service Code
|
NDC 0409-1634-01
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$48.95 |
| Rate for Payer: Aetna American Axle |
$35.35
|
| Rate for Payer: Aetna Commercial |
$46.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.35
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Cofinity Commercial |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$46.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.51
|
| Rate for Payer: Healthscope Commercial |
$48.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.23
|
| Rate for Payer: PHP Commercial |
$46.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.07
|
| Rate for Payer: Priority Health SBD |
$34.27
|
| Rate for Payer: UMR Bronson Commercial |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.79
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$38.35
|
|
|
Service Code
|
NDC 0143-9232-01
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$34.52 |
| Rate for Payer: Aetna American Axle |
$24.93
|
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.93
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$32.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.68
|
| Rate for Payer: Healthscope Commercial |
$34.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.60
|
| Rate for Payer: PHP Commercial |
$32.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.84
|
| Rate for Payer: Priority Health SBD |
$24.16
|
| Rate for Payer: UMR Bronson Commercial |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.76
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$38.35
|
|
|
Service Code
|
NDC 0143-9232-10
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$34.52 |
| Rate for Payer: Aetna American Axle |
$24.93
|
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.93
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$32.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.68
|
| Rate for Payer: Healthscope Commercial |
$34.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.60
|
| Rate for Payer: PHP Commercial |
$32.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.84
|
| Rate for Payer: Priority Health SBD |
$24.16
|
| Rate for Payer: UMR Bronson Commercial |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.76
|
|
