|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$74.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$325.92
|
|
|
Service Code
|
NDC 57664011688
|
| 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: Cofinity Medicare Advantage |
$228.14
|
| 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 Commercial |
$277.03
|
| Rate for Payer: PHP Commercial |
$277.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.85
|
| 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
|
OP
|
$325.92
|
|
|
Service Code
|
NDC 57664011688
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.59 |
| Max. Negotiated Rate |
$293.33 |
| Rate for Payer: Aetna American Axle |
$211.85
|
| Rate for Payer: Aetna Commercial |
$277.03
|
| Rate for Payer: Aetna Medicare |
$162.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.85
|
| Rate for Payer: BCBS Complete |
$130.37
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cofinity Commercial |
$228.14
|
| Rate for Payer: Cofinity Commercial |
$280.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.14
|
| 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 Commercial |
$277.03
|
| Rate for Payer: PHP Commercial |
$277.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.85
|
| Rate for Payer: Priority Health SBD |
$205.33
|
| Rate for Payer: UMR Bronson Commercial |
$120.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.44
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$786.72
|
|
|
Service Code
|
NDC 60687051501
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.09 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Aetna American Axle |
$511.37
|
| Rate for Payer: Aetna Commercial |
$668.71
|
| Rate for Payer: Aetna Medicare |
$393.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.37
|
| Rate for Payer: BCBS Complete |
$314.69
|
| Rate for Payer: Cash Price |
$629.38
|
| Rate for Payer: Cofinity Commercial |
$550.70
|
| Rate for Payer: Cofinity Commercial |
$676.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.70
|
| 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 Commercial |
$668.71
|
| Rate for Payer: PHP Commercial |
$668.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.37
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UMR Bronson Commercial |
$291.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.04
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
NDC 75834015901
|
| 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: Cofinity Medicare Advantage |
$146.30
|
| 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 Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| 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
|
$786.72
|
|
|
Service Code
|
NDC 60687051501
|
| 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: Cofinity Medicare Advantage |
$550.70
|
| 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 Commercial |
$668.71
|
| Rate for Payer: PHP Commercial |
$668.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.37
|
| 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
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
NDC 75834015901
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| 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 Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
8531
|
|
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: Cofinity Medicare Advantage |
$212.20
|
| 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 Commercial |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| 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 ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$7.87
|
|
|
Service Code
|
NDC 60687051511
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna American Axle |
$5.12
|
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.12
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.51
|
| 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 Commercial |
$6.69
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| Rate for Payer: Priority Health SBD |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.90
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$303.15
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
8531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna Medicare |
$151.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: BCBS Complete |
$121.26
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.20
|
| 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 Commercial |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.05
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$7.87
|
|
|
Service Code
|
NDC 60687051511
|
| 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: Cofinity Medicare Advantage |
$5.51
|
| 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 Commercial |
$6.69
|
| Rate for Payer: PHP Commercial |
$6.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| 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
|
|
|
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 Commercial |
$234.63
|
| Rate for Payer: Cofinity Commercial |
$288.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.63
|
| 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: PHP Commercial |
$284.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.87
|
| Rate for Payer: Priority Health SBD |
$211.16
|
| 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
|
$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 Commercial |
$11,731.15
|
| Rate for Payer: Cofinity Commercial |
$14,412.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,731.15
|
| 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: PHP Commercial |
$14,244.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,893.21
|
| 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
|
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 Commercial |
$234.63
|
| Rate for Payer: Cofinity Commercial |
$288.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.63
|
| 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: PHP Commercial |
$284.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.87
|
| 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
|
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 Commercial |
$11,731.15
|
| Rate for Payer: Cofinity Commercial |
$14,412.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,731.15
|
| 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: PHP Commercial |
$14,244.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,893.21
|
| Rate for Payer: Priority Health SBD |
$10,558.03
|
| 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
|
$1,254.75
|
|
|
Service Code
|
NDC 00456111030
|
| Hospital Charge Code |
152699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.09 |
| Max. Negotiated Rate |
$1,129.28 |
| Rate for Payer: Aetna American Axle |
$815.59
|
| Rate for Payer: Aetna Commercial |
$1,066.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.59
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,079.08
|
| Rate for Payer: Cofinity Commercial |
$878.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.80
|
| Rate for Payer: Healthscope Commercial |
$1,129.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$878.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$941.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.54
|
| Rate for Payer: PHP Commercial |
$1,066.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.59
|
| Rate for Payer: Priority Health SBD |
$790.49
|
| Rate for Payer: UMR Bronson Commercial |
$552.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$941.06
|
|
|
VILAZODONE 10 MG TABLET
|
Facility
|
OP
|
$1,254.75
|
|
|
Service Code
|
NDC 00456111030
|
| Hospital Charge Code |
152699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$1,129.28 |
| Rate for Payer: Aetna American Axle |
$815.59
|
| Rate for Payer: Aetna Commercial |
$1,066.54
|
| Rate for Payer: Aetna Medicare |
$627.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.59
|
| Rate for Payer: BCBS Complete |
$501.90
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,079.08
|
| Rate for Payer: Cofinity Commercial |
$878.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.80
|
| Rate for Payer: Healthscope Commercial |
$1,129.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$878.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$941.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.54
|
| Rate for Payer: PHP Commercial |
$1,066.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.59
|
| Rate for Payer: Priority Health SBD |
$790.49
|
| Rate for Payer: UMR Bronson Commercial |
$464.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$941.06
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$154.52
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.17 |
| Max. Negotiated Rate |
$139.07 |
| Rate for Payer: Aetna American Axle |
$100.44
|
| Rate for Payer: Aetna Commercial |
$131.34
|
| Rate for Payer: Aetna Medicare |
$77.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.44
|
| Rate for Payer: BCBS Complete |
$61.81
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Cofinity Commercial |
$108.16
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.62
|
| Rate for Payer: Healthscope Commercial |
$139.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.34
|
| Rate for Payer: PHP Commercial |
$131.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.44
|
| Rate for Payer: Priority Health SBD |
$97.35
|
| Rate for Payer: UMR Bronson Commercial |
$57.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.89
|
|
|
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 Commercial |
$368.92
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.92
|
| 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: PHP Commercial |
$447.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.57
|
| 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
|
|
|
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 |
$263.52
|
| 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 Commercial |
$368.92
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.92
|
| 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: PHP Commercial |
$447.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.57
|
| Rate for Payer: Priority Health SBD |
$332.03
|
| Rate for Payer: UMR Bronson Commercial |
$195.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.27
|
|
|
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 Commercial |
$597.20
|
| Rate for Payer: Cofinity Commercial |
$733.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.20
|
| 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 |
$597.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.18
|
| Rate for Payer: PHP Commercial |
$725.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.55
|
| 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
|
$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 |
$426.58
|
| 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 Commercial |
$597.20
|
| Rate for Payer: Cofinity Commercial |
$733.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.20
|
| 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 |
$597.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.18
|
| Rate for Payer: PHP Commercial |
$725.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.55
|
| Rate for Payer: Priority Health SBD |
$537.48
|
| 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
|
$154.52
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.99 |
| Max. Negotiated Rate |
$139.07 |
| Rate for Payer: Aetna American Axle |
$100.44
|
| Rate for Payer: Aetna Commercial |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.44
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Cofinity Commercial |
$108.16
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.62
|
| Rate for Payer: Healthscope Commercial |
$139.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.34
|
| Rate for Payer: PHP Commercial |
$131.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.44
|
| Rate for Payer: Priority Health SBD |
$97.35
|
| Rate for Payer: UMR Bronson Commercial |
$67.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.89
|
|
