|
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 |
$12.82 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$18.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.77
|
| Rate for Payer: Mclaren Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.12
|
|
|
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 |
$50.31 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: BCBS Trust/PPO |
$55.72
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
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 |
$50.31 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: BCBS Trust/PPO |
$55.72
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
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 |
$15,773.18 |
| Max. Negotiated Rate |
$22,533.11 |
| Rate for Payer: Aetna Commercial |
$20,279.80
|
| Rate for Payer: ASR ASR |
$21,857.12
|
| Rate for Payer: BCBS Trust/PPO |
$17,469.92
|
| Rate for Payer: BCN Commercial |
$17,469.92
|
| Rate for Payer: Cash Price |
$18,026.49
|
| Rate for Payer: Cofinity Commercial |
$21,181.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,026.49
|
| Rate for Payer: Healthscope Commercial |
$22,533.11
|
| Rate for Payer: Healthscope Whirlpool |
$21,857.12
|
| Rate for Payer: Mclaren Commercial |
$20,279.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,153.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,773.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19,829.14
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
IP
|
$36,275.57
|
|
|
Service Code
|
MS-DRG 263
|
| Min. Negotiated Rate |
$24,320.19 |
| Max. Negotiated Rate |
$36,275.57 |
| Rate for Payer: Aetna Medicare |
$25,600.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,000.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,000.25
|
| Rate for Payer: BCBS MAPPO |
$25,600.20
|
| Rate for Payer: BCN Medicare Advantage |
$25,600.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,600.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,600.20
|
| Rate for Payer: Mclaren Medicare |
$25,600.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,880.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,440.23
|
| Rate for Payer: PACE Medicare |
$24,320.19
|
| Rate for Payer: PACE SWMI |
$25,600.20
|
| Rate for Payer: PHP Commercial |
$28,160.22
|
| Rate for Payer: PHP Medicare Advantage |
$25,600.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,275.57
|
| Rate for Payer: Priority Health Medicare |
$25,600.20
|
| Rate for Payer: Priority Health Narrow Network |
$29,020.46
|
| Rate for Payer: Railroad Medicare Medicare |
$25,600.20
|
| Rate for Payer: UHC Medicare Advantage |
$26,368.21
|
| Rate for Payer: VA VA |
$25,600.20
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$264.96
|
|
|
Service Code
|
NDC 51079-480-20
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.47 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$238.46
|
| Rate for Payer: ASR ASR |
$257.01
|
| Rate for Payer: BCBS Trust/PPO |
$205.42
|
| Rate for Payer: BCN Commercial |
$205.42
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$249.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$264.96
|
| Rate for Payer: Healthscope Whirlpool |
$257.01
|
| Rate for Payer: Mclaren Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.16
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$4.14
|
|
|
Service Code
|
NDC 68084-844-11
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: ASR ASR |
$4.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.21
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Healthscope Whirlpool |
$4.02
|
| Rate for Payer: Mclaren Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.64
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$414.20
|
|
|
Service Code
|
NDC 68084-844-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.94 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Aetna Commercial |
$372.78
|
| Rate for Payer: ASR ASR |
$401.77
|
| Rate for Payer: BCBS Trust/PPO |
$321.13
|
| Rate for Payer: BCN Commercial |
$321.13
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$389.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$414.20
|
| Rate for Payer: Healthscope Whirlpool |
$401.77
|
| Rate for Payer: Mclaren Commercial |
$372.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.50
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079-480-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.05
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$293.55
|
|
|
Service Code
|
NDC 68382-019-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.48 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$264.20
|
| Rate for Payer: ASR ASR |
$284.74
|
| Rate for Payer: BCBS Trust/PPO |
$227.59
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$275.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$293.55
|
| Rate for Payer: Healthscope Whirlpool |
$284.74
|
| Rate for Payer: Mclaren Commercial |
$264.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.32
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$283.10
|
|
|
Service Code
|
NDC 0904-7075-61
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.17 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Aetna Commercial |
$254.79
|
| Rate for Payer: ASR ASR |
$274.61
|
| Rate for Payer: BCBS Trust/PPO |
$219.49
|
| Rate for Payer: BCN Commercial |
$219.49
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Commercial |
$266.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$283.10
|
| Rate for Payer: Healthscope Whirlpool |
$274.61
|
| Rate for Payer: Mclaren Commercial |
$254.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.13
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$294.50
|
|
|
Service Code
|
NDC 0904-6468-61
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.15 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: ASR ASR |
$285.66
|
| Rate for Payer: BCBS Trust/PPO |
$228.33
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.66
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$290.70
|
|
|
Service Code
|
NDC 0904-7077-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.49 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: BCBS Trust/PPO |
$225.38
|
| Rate for Payer: BCN Commercial |
$225.38
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084-709-01
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.18 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$418.10
|
| Rate for Payer: ASR ASR |
$450.61
|
| Rate for Payer: BCBS Trust/PPO |
$360.17
|
| Rate for Payer: BCN Commercial |
$360.17
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$436.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$464.55
|
| Rate for Payer: Healthscope Whirlpool |
$450.61
|
| Rate for Payer: Mclaren Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.80
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$296.40
|
|
|
Service Code
|
NDC 0904-6469-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.48 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: ASR ASR |
$287.51
|
| Rate for Payer: BCBS Trust/PPO |
$229.80
|
| Rate for Payer: BCN Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$278.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$287.51
|
| Rate for Payer: Mclaren Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.83
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$209.38
|
|
|
Service Code
|
NDC 65862-528-90
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.57 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna Commercial |
$188.44
|
| Rate for Payer: ASR ASR |
$203.10
|
| Rate for Payer: BCBS Trust/PPO |
$162.33
|
| Rate for Payer: BCN Commercial |
$162.33
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cofinity Commercial |
$196.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.50
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Healthscope Whirlpool |
$203.10
|
| Rate for Payer: Mclaren Commercial |
$188.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.25
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$226.57
|
|
|
Service Code
|
NDC 0093-7385-98
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.91
|
| Rate for Payer: ASR ASR |
$219.77
|
| Rate for Payer: BCBS Trust/PPO |
$175.66
|
| Rate for Payer: BCN Commercial |
$175.66
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$212.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$226.57
|
| Rate for Payer: Healthscope Whirlpool |
$219.77
|
| Rate for Payer: Mclaren Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.38
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: ASR ASR |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.61
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: Healthscope Whirlpool |
$4.51
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.09
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$66.78
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: ASR ASR |
$64.78
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$62.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$66.78
|
| Rate for Payer: Healthscope Whirlpool |
$64.78
|
| Rate for Payer: Mclaren Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.77
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$174.30
|
|
|
Service Code
|
NDC 0173-0682-20
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: ASR ASR |
$169.07
|
| Rate for Payer: BCBS Trust/PPO |
$135.13
|
| Rate for Payer: BCN Commercial |
$135.13
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Commercial |
$163.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.44
|
| Rate for Payer: Healthscope Commercial |
$174.30
|
| Rate for Payer: Healthscope Whirlpool |
$169.07
|
| Rate for Payer: Mclaren Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.38
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
IP
|
$27,654.79
|
|
|
Service Code
|
MS-DRG 032
|
| Min. Negotiated Rate |
$18,920.07 |
| Max. Negotiated Rate |
$27,654.79 |
| Rate for Payer: Aetna Medicare |
$19,915.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,894.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,894.82
|
| Rate for Payer: BCBS MAPPO |
$19,915.86
|
| Rate for Payer: BCN Medicare Advantage |
$19,915.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,915.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,915.86
|
| Rate for Payer: Mclaren Medicare |
$19,915.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,911.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,903.24
|
| Rate for Payer: PACE Medicare |
$18,920.07
|
| Rate for Payer: PACE SWMI |
$19,915.86
|
| Rate for Payer: PHP Commercial |
$21,907.45
|
| Rate for Payer: PHP Medicare Advantage |
$19,915.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,654.79
|
| Rate for Payer: Priority Health Medicare |
$19,915.86
|
| Rate for Payer: Priority Health Narrow Network |
$22,123.83
|
| Rate for Payer: Railroad Medicare Medicare |
$19,915.86
|
| Rate for Payer: UHC Medicare Advantage |
$20,513.34
|
| Rate for Payer: VA VA |
$19,915.86
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
IP
|
$52,857.14
|
|
|
Service Code
|
MS-DRG 031
|
| Min. Negotiated Rate |
$34,707.02 |
| Max. Negotiated Rate |
$52,857.14 |
| Rate for Payer: Aetna Medicare |
$36,533.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,667.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,667.12
|
| Rate for Payer: BCBS MAPPO |
$36,533.70
|
| Rate for Payer: BCN Medicare Advantage |
$36,533.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,533.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,533.70
|
| Rate for Payer: Mclaren Medicare |
$36,533.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38,360.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,013.76
|
| Rate for Payer: PACE Medicare |
$34,707.02
|
| Rate for Payer: PACE SWMI |
$36,533.70
|
| Rate for Payer: PHP Commercial |
$40,187.07
|
| Rate for Payer: PHP Medicare Advantage |
$36,533.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,857.14
|
| Rate for Payer: Priority Health Medicare |
$36,533.70
|
| Rate for Payer: Priority Health Narrow Network |
$42,285.71
|
| Rate for Payer: Railroad Medicare Medicare |
$36,533.70
|
| Rate for Payer: UHC Medicare Advantage |
$37,629.71
|
| Rate for Payer: VA VA |
$36,533.70
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$20,838.04
|
|
|
Service Code
|
MS-DRG 033
|
| Min. Negotiated Rate |
$14,650.00 |
| Max. Negotiated Rate |
$20,838.04 |
| Rate for Payer: Aetna Medicare |
$15,421.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,276.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,276.31
|
| Rate for Payer: BCBS MAPPO |
$15,421.05
|
| Rate for Payer: BCN Medicare Advantage |
$15,421.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,421.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,421.05
|
| Rate for Payer: Mclaren Medicare |
$15,421.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,192.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,734.21
|
| Rate for Payer: PACE Medicare |
$14,650.00
|
| Rate for Payer: PACE SWMI |
$15,421.05
|
| Rate for Payer: PHP Commercial |
$16,963.16
|
| Rate for Payer: PHP Medicare Advantage |
$15,421.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,838.04
|
| Rate for Payer: Priority Health Medicare |
$15,421.05
|
| Rate for Payer: Priority Health Narrow Network |
$16,670.43
|
| Rate for Payer: Railroad Medicare Medicare |
$15,421.05
|
| Rate for Payer: UHC Medicare Advantage |
$15,883.68
|
| Rate for Payer: VA VA |
$15,421.05
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$21.65
|
|
|
Service Code
|
NDC 70756-605-82
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: ASR ASR |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.79
|
| Rate for Payer: BCN Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$21.65
|
| Rate for Payer: Healthscope Whirlpool |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.05
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$22.22
|
|
|
Service Code
|
NDC 70756-605-25
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.22 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: ASR ASR |
$21.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.23
|
| Rate for Payer: BCN Commercial |
$17.23
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$20.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$22.22
|
| Rate for Payer: Healthscope Whirlpool |
$21.55
|
| Rate for Payer: Mclaren Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.55
|
|
