|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$29,767.46
|
|
|
Service Code
|
APR-DRG 3104
|
| Min. Negotiated Rate |
$28,349.96 |
| Max. Negotiated Rate |
$29,767.46 |
| Rate for Payer: BCBS Complete |
$29,767.46
|
| Rate for Payer: Mclaren Medicaid |
$28,349.96
|
| Rate for Payer: Meridian Medicaid |
$29,767.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$28,349.96
|
| Rate for Payer: UHC Medicaid |
$28,349.96
|
| Rate for Payer: UHCCP Medicaid |
$28,349.96
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$9,124.06
|
|
|
Service Code
|
APR-DRG 3101
|
| Min. Negotiated Rate |
$8,689.58 |
| Max. Negotiated Rate |
$9,124.06 |
| Rate for Payer: BCBS Complete |
$9,124.06
|
| Rate for Payer: Mclaren Medicaid |
$8,689.58
|
| Rate for Payer: Meridian Medicaid |
$9,124.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,689.58
|
| Rate for Payer: UHC Medicaid |
$8,689.58
|
| Rate for Payer: UHCCP Medicaid |
$8,689.58
|
|
|
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, SINGLE SEGMENT
|
Facility
|
OP
|
$18,057.01
|
|
|
Service Code
|
CPT 63081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18,057.01 |
| Max. Negotiated Rate |
$18,057.01 |
| Rate for Payer: BCBS Trust/PPO |
$18,057.01
|
| Rate for Payer: BCN Commercial |
$18,057.01
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$6,289.33
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$5,989.84 |
| Max. Negotiated Rate |
$6,289.33 |
| Rate for Payer: BCBS Complete |
$6,289.33
|
| Rate for Payer: Mclaren Medicaid |
$5,989.84
|
| Rate for Payer: Meridian Medicaid |
$6,289.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,989.84
|
| Rate for Payer: UHC Medicaid |
$5,989.84
|
| Rate for Payer: UHCCP Medicaid |
$5,989.84
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$5,063.54
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$4,822.42 |
| Max. Negotiated Rate |
$5,063.54 |
| Rate for Payer: BCBS Complete |
$5,063.54
|
| Rate for Payer: Mclaren Medicaid |
$4,822.42
|
| Rate for Payer: Meridian Medicaid |
$5,063.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,822.42
|
| Rate for Payer: UHC Medicaid |
$4,822.42
|
| Rate for Payer: UHCCP Medicaid |
$4,822.42
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$9,459.41
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$9,008.97 |
| Max. Negotiated Rate |
$9,459.41 |
| Rate for Payer: BCBS Complete |
$9,459.41
|
| Rate for Payer: Mclaren Medicaid |
$9,008.97
|
| Rate for Payer: Meridian Medicaid |
$9,459.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,008.97
|
| Rate for Payer: UHC Medicaid |
$9,008.97
|
| Rate for Payer: UHCCP Medicaid |
$9,008.97
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$4,383.76
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$4,175.01 |
| Max. Negotiated Rate |
$4,383.76 |
| Rate for Payer: BCBS Complete |
$4,383.76
|
| Rate for Payer: Mclaren Medicaid |
$4,175.01
|
| Rate for Payer: Meridian Medicaid |
$4,383.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,175.01
|
| Rate for Payer: UHC Medicaid |
$4,175.01
|
| Rate for Payer: UHCCP Medicaid |
$4,175.01
|
|
|
VIGABATRIN 500 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$335.18
|
|
|
Service Code
|
NDC 49884035852
|
| Hospital Charge Code |
99413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$301.66 |
| Rate for Payer: Aetna American Axle |
$217.87
|
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Aetna Medicare |
$167.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.87
|
| Rate for Payer: BCBS Complete |
$134.07
|
| Rate for Payer: Cash Price |
$268.14
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$268.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.38
|
| Rate for Payer: PHP Commercial |
$284.90
|
| Rate for Payer: Priority Health SBD |
$211.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.87
|
| Rate for Payer: UHC Core |
$174.63
|
| Rate for Payer: UHC Exchange |
$131.73
|
| Rate for Payer: UMR Bronson Commercial |
$124.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.38
|
|
|
VIGABATRIN 500 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$335.18
|
|
|
Service Code
|
NDC 49884035852
|
| 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 Advantage |
$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 Commercial |
$284.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.38
|
| Rate for Payer: PHP Commercial |
$284.90
|
| 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 49884035803
|
| 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 Advantage |
$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 Commercial |
$14,244.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,569.08
|
| Rate for Payer: PHP Commercial |
$14,244.96
|
| 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
|
|
|
VIGABATRIN 500 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$16,758.78
|
|
|
Service Code
|
NDC 49884035803
|
| Hospital Charge Code |
99413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,200.75 |
| 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 Medicare |
$8,379.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,893.21
|
| Rate for Payer: BCBS Complete |
$6,703.51
|
| Rate for Payer: Cash Price |
$13,407.02
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$13,407.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,244.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,569.08
|
| Rate for Payer: PHP Commercial |
$14,244.96
|
| Rate for Payer: Priority Health SBD |
$10,558.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,893.21
|
| Rate for Payer: UHC Core |
$8,731.32
|
| Rate for Payer: UHC Exchange |
$6,586.20
|
| Rate for Payer: UMR Bronson Commercial |
$6,200.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,569.08
|
|
|
VILAZODONE 10 MG TABLET
|
Facility
|
IP
|
$1,317.46
|
|
|
Service Code
|
NDC 00456111030
|
| Hospital Charge Code |
152699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$579.68 |
| Max. Negotiated Rate |
$1,185.71 |
| Rate for Payer: Aetna American Axle |
$856.35
|
| Rate for Payer: Aetna Commercial |
$1,119.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.35
|
| Rate for Payer: Cash Price |
$1,053.97
|
| Rate for Payer: Cofinity Advantage |
$922.22
|
| Rate for Payer: Cofinity Commercial |
$1,133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.97
|
| Rate for Payer: Healthscope Commercial |
$1,185.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$922.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$988.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$988.10
|
| Rate for Payer: PHP Commercial |
$1,119.84
|
| Rate for Payer: Priority Health SBD |
$830.00
|
| Rate for Payer: UMR Bronson Commercial |
$579.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$988.10
|
|
|
VILAZODONE 10 MG TABLET
|
Facility
|
OP
|
$1,317.46
|
|
|
Service Code
|
NDC 00456111030
|
| Hospital Charge Code |
152699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.46 |
| Max. Negotiated Rate |
$1,185.71 |
| Rate for Payer: Aetna American Axle |
$856.35
|
| Rate for Payer: Aetna Commercial |
$1,119.84
|
| Rate for Payer: Aetna Medicare |
$658.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.35
|
| Rate for Payer: BCBS Complete |
$526.98
|
| Rate for Payer: Cash Price |
$1,053.97
|
| Rate for Payer: Cofinity Advantage |
$922.22
|
| Rate for Payer: Cofinity Commercial |
$1,133.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.97
|
| Rate for Payer: Healthscope Commercial |
$1,185.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$922.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$988.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,053.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$988.10
|
| Rate for Payer: PHP Commercial |
$1,119.84
|
| Rate for Payer: Priority Health SBD |
$830.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.35
|
| Rate for Payer: UHC Core |
$686.40
|
| Rate for Payer: UHC Exchange |
$517.76
|
| Rate for Payer: UMR Bronson Commercial |
$487.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$988.10
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$853.15
|
|
|
Service Code
|
NDC 16729035310
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.39 |
| Max. Negotiated Rate |
$767.84 |
| Rate for Payer: Aetna American Axle |
$554.55
|
| Rate for Payer: Aetna Commercial |
$725.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.55
|
| Rate for Payer: Cash Price |
$682.52
|
| Rate for Payer: Cofinity Advantage |
$597.21
|
| Rate for Payer: Cofinity Commercial |
$733.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.52
|
| Rate for Payer: Healthscope Commercial |
$767.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.86
|
| Rate for Payer: PHP Commercial |
$725.18
|
| Rate for Payer: Priority Health SBD |
$537.48
|
| Rate for Payer: UMR Bronson Commercial |
$375.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.86
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$527.03
|
|
|
Service Code
|
NDC 60505477303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$474.33 |
| Rate for Payer: Aetna American Axle |
$342.57
|
| Rate for Payer: Aetna Commercial |
$447.98
|
| Rate for Payer: Aetna Medicare |
$263.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.57
|
| Rate for Payer: BCBS Complete |
$210.81
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Advantage |
$368.92
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$474.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.27
|
| Rate for Payer: PHP Commercial |
$447.98
|
| Rate for Payer: Priority Health SBD |
$332.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.57
|
| Rate for Payer: UHC Core |
$274.58
|
| Rate for Payer: UHC Exchange |
$207.12
|
| Rate for Payer: UMR Bronson Commercial |
$195.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.27
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$542.24
|
|
|
Service Code
|
NDC 62332023330
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.63 |
| Max. Negotiated Rate |
$488.02 |
| Rate for Payer: Aetna American Axle |
$352.46
|
| Rate for Payer: Aetna Commercial |
$460.90
|
| Rate for Payer: Aetna Medicare |
$271.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.46
|
| Rate for Payer: BCBS Complete |
$216.90
|
| Rate for Payer: Cash Price |
$433.79
|
| Rate for Payer: Cofinity Advantage |
$379.57
|
| Rate for Payer: Cofinity Commercial |
$466.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.79
|
| Rate for Payer: Healthscope Commercial |
$488.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.68
|
| Rate for Payer: PHP Commercial |
$460.90
|
| Rate for Payer: Priority Health SBD |
$341.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.46
|
| Rate for Payer: UHC Core |
$282.51
|
| Rate for Payer: UHC Exchange |
$213.10
|
| Rate for Payer: UMR Bronson Commercial |
$200.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.68
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$853.15
|
|
|
Service Code
|
NDC 16729035310
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.67 |
| Max. Negotiated Rate |
$767.84 |
| Rate for Payer: Aetna American Axle |
$554.55
|
| Rate for Payer: Aetna Commercial |
$725.18
|
| Rate for Payer: Aetna Medicare |
$426.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.55
|
| Rate for Payer: BCBS Complete |
$341.26
|
| Rate for Payer: Cash Price |
$682.52
|
| Rate for Payer: Cofinity Advantage |
$597.21
|
| Rate for Payer: Cofinity Commercial |
$733.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.52
|
| Rate for Payer: Healthscope Commercial |
$767.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$682.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.86
|
| Rate for Payer: PHP Commercial |
$725.18
|
| Rate for Payer: Priority Health SBD |
$537.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.55
|
| Rate for Payer: UHC Core |
$444.49
|
| Rate for Payer: UHC Exchange |
$335.29
|
| Rate for Payer: UMR Bronson Commercial |
$315.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.86
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$166.18
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$149.56 |
| Rate for Payer: Aetna American Axle |
$108.02
|
| Rate for Payer: Aetna Commercial |
$141.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.02
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Advantage |
$116.33
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$149.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.64
|
| Rate for Payer: PHP Commercial |
$141.25
|
| Rate for Payer: Priority Health SBD |
$104.69
|
| Rate for Payer: UMR Bronson Commercial |
$73.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.64
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$166.18
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$149.56 |
| Rate for Payer: Aetna American Axle |
$108.02
|
| Rate for Payer: Aetna Commercial |
$141.25
|
| Rate for Payer: Aetna Medicare |
$83.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.02
|
| Rate for Payer: BCBS Complete |
$66.47
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Advantage |
$116.33
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$149.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.64
|
| Rate for Payer: PHP Commercial |
$141.25
|
| Rate for Payer: Priority Health SBD |
$104.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.02
|
| Rate for Payer: UHC Core |
$86.58
|
| Rate for Payer: UHC Exchange |
$65.31
|
| Rate for Payer: UMR Bronson Commercial |
$61.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.64
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$542.24
|
|
|
Service Code
|
NDC 62332023330
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.59 |
| Max. Negotiated Rate |
$488.02 |
| Rate for Payer: Aetna American Axle |
$352.46
|
| Rate for Payer: Aetna Commercial |
$460.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.46
|
| Rate for Payer: Cash Price |
$433.79
|
| Rate for Payer: Cofinity Advantage |
$379.57
|
| Rate for Payer: Cofinity Commercial |
$466.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.79
|
| Rate for Payer: Healthscope Commercial |
$488.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.68
|
| Rate for Payer: PHP Commercial |
$460.90
|
| Rate for Payer: Priority Health SBD |
$341.61
|
| Rate for Payer: UMR Bronson Commercial |
$238.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.68
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$527.03
|
|
|
Service Code
|
NDC 60505477303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.89 |
| Max. Negotiated Rate |
$474.33 |
| Rate for Payer: Aetna American Axle |
$342.57
|
| Rate for Payer: Aetna Commercial |
$447.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.57
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Advantage |
$368.92
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$474.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.27
|
| Rate for Payer: PHP Commercial |
$447.98
|
| Rate for Payer: Priority Health SBD |
$332.03
|
| Rate for Payer: UMR Bronson Commercial |
$231.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.27
|
|
|
VILOXAZINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,376.85
|
|
|
Service Code
|
NDC 17772013130
|
| Hospital Charge Code |
196961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.43 |
| Max. Negotiated Rate |
$1,239.16 |
| Rate for Payer: Aetna American Axle |
$894.95
|
| Rate for Payer: Aetna Commercial |
$1,170.32
|
| Rate for Payer: Aetna Medicare |
$688.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.95
|
| Rate for Payer: BCBS Complete |
$550.74
|
| Rate for Payer: Cash Price |
$1,101.48
|
| Rate for Payer: Cofinity Advantage |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.48
|
| Rate for Payer: Healthscope Commercial |
$1,239.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,101.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.64
|
| Rate for Payer: PHP Commercial |
$1,170.32
|
| Rate for Payer: Priority Health SBD |
$867.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.95
|
| Rate for Payer: UHC Core |
$717.34
|
| Rate for Payer: UHC Exchange |
$541.10
|
| Rate for Payer: UMR Bronson Commercial |
$509.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.64
|
|
|
VILOXAZINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,376.85
|
|
|
Service Code
|
NDC 17772013130
|
| Hospital Charge Code |
196961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.81 |
| Max. Negotiated Rate |
$1,239.16 |
| Rate for Payer: Aetna American Axle |
$894.95
|
| Rate for Payer: Aetna Commercial |
$1,170.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.95
|
| Rate for Payer: Cash Price |
$1,101.48
|
| Rate for Payer: Cofinity Advantage |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.48
|
| Rate for Payer: Healthscope Commercial |
$1,239.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.64
|
| Rate for Payer: PHP Commercial |
$1,170.32
|
| Rate for Payer: Priority Health SBD |
$867.42
|
| Rate for Payer: UMR Bronson Commercial |
$605.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.64
|
|
|
VILOXAZINE ER 200 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,376.85
|
|
|
Service Code
|
NDC 17772013330
|
| Hospital Charge Code |
196963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.81 |
| Max. Negotiated Rate |
$1,239.16 |
| Rate for Payer: Aetna American Axle |
$894.95
|
| Rate for Payer: Aetna Commercial |
$1,170.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.95
|
| Rate for Payer: Cash Price |
$1,101.48
|
| Rate for Payer: Cofinity Advantage |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.48
|
| Rate for Payer: Healthscope Commercial |
$1,239.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.64
|
| Rate for Payer: PHP Commercial |
$1,170.32
|
| Rate for Payer: Priority Health SBD |
$867.42
|
| Rate for Payer: UMR Bronson Commercial |
$605.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.64
|
|
|
VILOXAZINE ER 200 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,376.85
|
|
|
Service Code
|
NDC 17772013330
|
| Hospital Charge Code |
196963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.43 |
| Max. Negotiated Rate |
$1,239.16 |
| Rate for Payer: Aetna American Axle |
$894.95
|
| Rate for Payer: Aetna Commercial |
$1,170.32
|
| Rate for Payer: Aetna Medicare |
$688.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.95
|
| Rate for Payer: BCBS Complete |
$550.74
|
| Rate for Payer: Cash Price |
$1,101.48
|
| Rate for Payer: Cofinity Advantage |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.48
|
| Rate for Payer: Healthscope Commercial |
$1,239.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,101.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.64
|
| Rate for Payer: PHP Commercial |
$1,170.32
|
| Rate for Payer: Priority Health SBD |
$867.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.95
|
| Rate for Payer: UHC Core |
$717.34
|
| Rate for Payer: UHC Exchange |
$541.10
|
| Rate for Payer: UMR Bronson Commercial |
$509.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.64
|
|
