|
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
|
$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 |
$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 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 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 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44.98
|
|
|
Service Code
|
NDC 47335-932-44
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna American Axle |
$29.24
|
| Rate for Payer: Aetna Commercial |
$38.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.24
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Cofinity Commercial |
$31.49
|
| Rate for Payer: Cofinity Commercial |
$38.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.98
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.23
|
| Rate for Payer: PHP Commercial |
$38.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.49
|
| Rate for Payer: Priority Health SBD |
$28.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.74
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.49
|
|
|
Service Code
|
NDC 55150-236-21
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.42
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.14
|
|
|
Service Code
|
NDC 55390-039-10
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$46.03 |
| Rate for Payer: Aetna American Axle |
$33.24
|
| Rate for Payer: Aetna Commercial |
$43.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.24
|
| Rate for Payer: Cash Price |
$40.91
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Cofinity Commercial |
$43.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.91
|
| Rate for Payer: Healthscope Commercial |
$46.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.47
|
| Rate for Payer: PHP Commercial |
$43.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$32.22
|
| Rate for Payer: UMR Bronson Commercial |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.36
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34.17
|
|
|
Service Code
|
NDC 0409-1634-85
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Aetna American Axle |
$22.21
|
| Rate for Payer: Aetna Commercial |
$29.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.21
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Cofinity Commercial |
$29.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$30.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.04
|
| Rate for Payer: PHP Commercial |
$29.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.92
|
| Rate for Payer: Priority Health SBD |
$21.53
|
| Rate for Payer: UMR Bronson Commercial |
$15.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.63
|
|
|
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
|
|
|
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
|
$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
|
$71.87
|
|
|
Service Code
|
NDC 41616-932-40
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$31.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.87
|
|
|
Service Code
|
NDC 41616-932-44
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$31.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
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
|
$49.88
|
|
|
Service Code
|
NDC 63323-782-20
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna American Axle |
$32.42
|
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.40
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: UMR Bronson Commercial |
$21.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.49
|
|
|
Service Code
|
NDC 55150-236-02
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$18.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.42
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.34
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.37
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.08
|
|
|
Service Code
|
NDC 55150-236-01
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna American Axle |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$17.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.07
|
| Rate for Payer: PHP Commercial |
$17.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.06
|
| Rate for Payer: Priority Health SBD |
$12.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.06
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44.98
|
|
|
Service Code
|
NDC 47335-932-40
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna American Axle |
$29.24
|
| Rate for Payer: Aetna Commercial |
$38.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.24
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Cofinity Commercial |
$31.49
|
| Rate for Payer: Cofinity Commercial |
$38.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.98
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.23
|
| Rate for Payer: PHP Commercial |
$38.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.49
|
| Rate for Payer: Priority Health SBD |
$28.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.74
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.08
|
|
|
Service Code
|
NDC 55150-236-20
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna American Axle |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$14.06
|
| Rate for Payer: Cofinity Commercial |
$17.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.07
|
| Rate for Payer: PHP Commercial |
$17.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.06
|
| Rate for Payer: Priority Health SBD |
$12.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.06
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.98
|
|
|
Service Code
|
NDC 67457-475-20
|
| 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 IV SOLUTION FOR DRIP
|
Facility
|
IP
|
$51.14
|
|
|
Service Code
|
NDC 55390-039-10
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$46.03 |
| Rate for Payer: Aetna American Axle |
$33.24
|
| Rate for Payer: Aetna Commercial |
$43.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.24
|
| Rate for Payer: Cash Price |
$40.91
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Cofinity Commercial |
$43.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.91
|
| Rate for Payer: Healthscope Commercial |
$46.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.47
|
| Rate for Payer: PHP Commercial |
$43.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$32.22
|
| Rate for Payer: UMR Bronson Commercial |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.36
|
|
|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
IP
|
$71.87
|
|
|
Service Code
|
NDC 41616-932-40
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$31.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
IP
|
$71.87
|
|
|
Service Code
|
NDC 41616-932-44
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$31.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22,533.11
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,914.57 |
| Max. Negotiated Rate |
$20,279.80 |
| Rate for Payer: Aetna American Axle |
$14,646.52
|
| Rate for Payer: Aetna Commercial |
$19,153.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,646.52
|
| Rate for Payer: Cash Price |
$18,026.49
|
| Rate for Payer: Cofinity Commercial |
$15,773.18
|
| Rate for Payer: Cofinity Commercial |
$19,378.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,026.49
|
| Rate for Payer: Healthscope Commercial |
$20,279.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,773.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,899.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,153.14
|
| Rate for Payer: PHP Commercial |
$19,153.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,773.18
|
| Rate for Payer: Priority Health SBD |
$14,195.86
|
| Rate for Payer: UMR Bronson Commercial |
$9,914.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,899.83
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22,533.11
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$20,279.80 |
| Rate for Payer: Aetna American Axle |
$14,646.52
|
| Rate for Payer: Aetna Commercial |
$19,153.14
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,646.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.58
|
| Rate for Payer: BCBS Complete |
$12.67
|
| Rate for Payer: BCBS MAPPO |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$71.27
|
| Rate for Payer: BCN Medicare Advantage |
$22.06
|
| Rate for Payer: Cash Price |
$18,026.49
|
| Rate for Payer: Cash Price |
$18,026.49
|
| Rate for Payer: Cofinity Commercial |
$15,773.18
|
| Rate for Payer: Cofinity Commercial |
$19,378.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,026.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.06
|
| Rate for Payer: Healthscope Commercial |
$20,279.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,773.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,899.83
|
| Rate for Payer: Mclaren Medicaid |
$12.07
|
| Rate for Payer: Mclaren Medicare |
$22.06
|
| Rate for Payer: Meridian Medicaid |
$12.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,153.14
|
| Rate for Payer: PACE Medicare |
$20.96
|
| Rate for Payer: PACE SWMI |
$22.06
|
| Rate for Payer: PHP Commercial |
$19,153.14
|
| Rate for Payer: PHP Medicare Advantage |
$22.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,773.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.49
|
| Rate for Payer: Priority Health Medicare |
$22.06
|
| Rate for Payer: Priority Health Narrow Network |
$52.39
|
| Rate for Payer: Priority Health SBD |
$14,195.86
|
| Rate for Payer: Railroad Medicare Medicare |
$22.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.06
|
| Rate for Payer: UHC Medicare Advantage |
$22.72
|
| Rate for Payer: UMR Bronson Commercial |
$8,337.25
|
| Rate for Payer: VA VA |
$22.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,899.83
|
|
