|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
NDC 70069-272-01
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.69
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.73
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.91
|
|
|
Service Code
|
NDC 55150-343-05
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna American Axle |
$11.64
|
| Rate for Payer: Aetna Commercial |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.64
|
| Rate for Payer: Cash Price |
$14.33
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$11.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.43
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
NDC 70121-1586-3
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32.47
|
|
|
Service Code
|
NDC 72485-109-05
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna American Axle |
$21.11
|
| Rate for Payer: Aetna Commercial |
$27.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.11
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$27.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.60
|
| Rate for Payer: PHP Commercial |
$27.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.73
|
| Rate for Payer: Priority Health SBD |
$20.46
|
| Rate for Payer: UMR Bronson Commercial |
$14.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.35
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$107.64
|
|
|
Service Code
|
NDC 0409-1144-01
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$96.88 |
| Rate for Payer: Aetna American Axle |
$69.97
|
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.97
|
| Rate for Payer: Cash Price |
$86.11
|
| Rate for Payer: Cofinity Commercial |
$75.35
|
| Rate for Payer: Cofinity Commercial |
$92.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.11
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.49
|
| Rate for Payer: PHP Commercial |
$91.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: Priority Health SBD |
$67.81
|
| Rate for Payer: UMR Bronson Commercial |
$47.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.73
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
NDC 70756-605-82
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.23
|
|
|
Service Code
|
NDC 0409-1144-62
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$20.91 |
| Rate for Payer: Aetna American Axle |
$15.10
|
| 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 |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$19.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$20.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.42
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.42
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
NDC 70069-272-05
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.69
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.73
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$315.49
|
|
|
Service Code
|
NDC 0409-9633-05
|
| Hospital Charge Code |
112139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.82 |
| Max. Negotiated Rate |
$283.94 |
| Rate for Payer: Aetna American Axle |
$205.07
|
| Rate for Payer: Aetna Commercial |
$268.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.07
|
| Rate for Payer: Cash Price |
$252.39
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.39
|
| Rate for Payer: Healthscope Commercial |
$283.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.17
|
| Rate for Payer: PHP Commercial |
$268.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health SBD |
$198.76
|
| Rate for Payer: UMR Bronson Commercial |
$138.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.62
|
|
|
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 |
$133.39 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| 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: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$133.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
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 |
$152.00 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| 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 |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE
|
Facility
|
IP
|
$1,310.17
|
|
|
Service Code
|
NDC 62175-485-37
|
| Hospital Charge Code |
88029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$576.47 |
| Max. Negotiated Rate |
$1,179.15 |
| Rate for Payer: Aetna American Axle |
$851.61
|
| Rate for Payer: Aetna Commercial |
$1,113.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.61
|
| Rate for Payer: Cash Price |
$1,048.14
|
| Rate for Payer: Cofinity Commercial |
$1,126.75
|
| Rate for Payer: Cofinity Commercial |
$917.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.14
|
| Rate for Payer: Healthscope Commercial |
$1,179.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$917.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,113.64
|
| Rate for Payer: PHP Commercial |
$1,113.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.12
|
| Rate for Payer: Priority Health SBD |
$825.41
|
| Rate for Payer: UMR Bronson Commercial |
$576.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.63
|
|
|
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 |
$927.63 |
| Max. Negotiated Rate |
$1,897.43 |
| Rate for Payer: Aetna American Axle |
$1,370.37
|
| 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: Encore Health Key Benefits Commercial |
$1,686.61
|
| Rate for Payer: Healthscope Commercial |
$1,897.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,581.20
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$927.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,581.20
|
|
|
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 |
$230.84 |
| Max. Negotiated Rate |
$472.18 |
| Rate for Payer: Aetna American Axle |
$341.02
|
| 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: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$472.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.48
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$230.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.48
|
|
|
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 |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| 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: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$325.92
|
|
|
Service Code
|
NDC 57664-116-88
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$293.33 |
| Rate for Payer: Aetna American Axle |
$211.85
|
| Rate for Payer: Aetna Commercial |
$277.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.85
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cofinity Commercial |
$228.14
|
| Rate for Payer: Cofinity Commercial |
$280.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.74
|
| Rate for Payer: Healthscope Commercial |
$293.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.03
|
| Rate for Payer: PHP Commercial |
$277.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.14
|
| Rate for Payer: Priority Health SBD |
$205.33
|
| Rate for Payer: UMR Bronson Commercial |
$143.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.44
|
|
|
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 |
$2.31 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna American Axle |
$3.41
|
| 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: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.94
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.94
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 68462-293-01
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.91
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
NDC 68462-260-01
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.46
|
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 75834-159-01
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3,070.26
|
|
|
Service Code
|
NDC 0025-1891-31
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,350.91 |
| Max. Negotiated Rate |
$2,763.23 |
| Rate for Payer: Aetna American Axle |
$1,995.67
|
| Rate for Payer: Aetna Commercial |
$2,609.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,995.67
|
| Rate for Payer: Cash Price |
$2,456.21
|
| Rate for Payer: Cofinity Commercial |
$2,149.18
|
| Rate for Payer: Cofinity Commercial |
$2,640.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,456.21
|
| Rate for Payer: Healthscope Commercial |
$2,763.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,149.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,302.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,609.72
|
| Rate for Payer: PHP Commercial |
$2,609.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,149.18
|
| Rate for Payer: Priority Health SBD |
$1,934.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,350.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,302.70
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$7.87
|
|
|
Service Code
|
NDC 60687-515-11
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$7.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.69
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.51
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.90
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$786.72
|
|
|
Service Code
|
NDC 60687-515-01
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.16 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Aetna American Axle |
$511.37
|
| Rate for Payer: Aetna Commercial |
$668.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.37
|
| Rate for Payer: Cash Price |
$629.38
|
| Rate for Payer: Cofinity Commercial |
$550.70
|
| Rate for Payer: Cofinity Commercial |
$676.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.38
|
| Rate for Payer: Healthscope Commercial |
$708.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$550.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.71
|
| Rate for Payer: PHP Commercial |
$668.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.70
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UMR Bronson Commercial |
$346.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.04
|
|
|
VIGABATRIN 500 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$335.18
|
|
|
Service Code
|
NDC 49884-358-52
|
| Hospital Charge Code |
99413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.48 |
| Max. Negotiated Rate |
$301.66 |
| Rate for Payer: Aetna American Axle |
$217.87
|
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.87
|
| Rate for Payer: Cash Price |
$268.14
|
| Rate for Payer: Cofinity Commercial |
$234.63
|
| Rate for Payer: Cofinity Commercial |
$288.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.14
|
| Rate for Payer: Healthscope Commercial |
$301.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.90
|
| Rate for Payer: PHP Commercial |
$284.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.63
|
| Rate for Payer: Priority Health SBD |
$211.16
|
| Rate for Payer: UMR Bronson Commercial |
$147.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.38
|
|
|
VIGABATRIN 500 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$16,758.78
|
|
|
Service Code
|
NDC 49884-358-03
|
| Hospital Charge Code |
99413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,373.86 |
| Max. Negotiated Rate |
$15,082.90 |
| Rate for Payer: Aetna American Axle |
$10,893.21
|
| Rate for Payer: Aetna Commercial |
$14,244.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,893.21
|
| Rate for Payer: Cash Price |
$13,407.02
|
| Rate for Payer: Cofinity Commercial |
$11,731.15
|
| Rate for Payer: Cofinity Commercial |
$14,412.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,407.02
|
| Rate for Payer: Healthscope Commercial |
$15,082.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,731.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,569.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,244.96
|
| Rate for Payer: PHP Commercial |
$14,244.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,731.15
|
| Rate for Payer: Priority Health SBD |
$10,558.03
|
| Rate for Payer: UMR Bronson Commercial |
$7,373.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,569.08
|
|
