|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$113.39
|
|
|
Service Code
|
NDC 0409-1144-05
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.37 |
| Max. Negotiated Rate |
$113.39 |
| Rate for Payer: Aetna Commercial |
$102.05
|
| Rate for Payer: ASR ASR |
$109.99
|
| Rate for Payer: BCBS Trust/PPO |
$87.91
|
| Rate for Payer: BCN Commercial |
$87.91
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.71
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Whirlpool |
$109.99
|
| Rate for Payer: Mclaren Commercial |
$102.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$26.95
|
|
|
Service Code
|
NDC 67850-071-00
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna Commercial |
$24.26
|
| Rate for Payer: ASR ASR |
$26.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cofinity Commercial |
$25.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Healthscope Whirlpool |
$26.14
|
| Rate for Payer: Mclaren Commercial |
$24.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.72
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710-1643-1
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$37.25
|
|
|
Service Code
|
NDC 0409-4011-01
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: BCBS Trust/PPO |
$28.88
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$25.74
|
|
|
Service Code
|
NDC 67850-071-25
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$25.74 |
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: ASR ASR |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$19.96
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$25.74
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Mclaren Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.65
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710-1643-7
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
IP
|
$12.16
|
|
|
Service Code
|
NDC 51079-917-01
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.43
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
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 |
$3.68 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
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 |
$136.32 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna Commercial |
$175.28
|
| Rate for Payer: ASR ASR |
$188.91
|
| Rate for Payer: BCBS Trust/PPO |
$150.99
|
| Rate for Payer: BCN Commercial |
$150.99
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$194.75
|
| Rate for Payer: Healthscope Whirlpool |
$188.91
|
| Rate for Payer: Mclaren Commercial |
$175.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.38
|
|
|
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 |
$367.25 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: BCBS Trust/PPO |
$406.75
|
| Rate for Payer: BCN Commercial |
$406.75
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$493.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$524.64
|
| Rate for Payer: Healthscope Whirlpool |
$508.90
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
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 |
$259.91 |
| Max. Negotiated Rate |
$371.30 |
| Rate for Payer: Aetna Commercial |
$334.17
|
| Rate for Payer: ASR ASR |
$360.16
|
| Rate for Payer: BCBS Trust/PPO |
$287.87
|
| Rate for Payer: BCN Commercial |
$287.87
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$349.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$371.30
|
| Rate for Payer: Healthscope Whirlpool |
$360.16
|
| Rate for Payer: Mclaren Commercial |
$334.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.74
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$561.60
|
|
|
Service Code
|
NDC 60687-504-01
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: ASR ASR |
$544.75
|
| Rate for Payer: BCBS Trust/PPO |
$435.41
|
| Rate for Payer: BCN Commercial |
$435.41
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Commercial |
$527.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Mclaren Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$5.62
|
|
|
Service Code
|
NDC 60687-504-11
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: ASR ASR |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.45
|
| Rate for Payer: Mclaren Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
IP
|
$527.03
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.92 |
| Max. Negotiated Rate |
$527.03 |
| Rate for Payer: Aetna Commercial |
$474.33
|
| Rate for Payer: ASR ASR |
$511.22
|
| Rate for Payer: BCBS Trust/PPO |
$408.61
|
| Rate for Payer: BCN Commercial |
$408.61
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Commercial |
$495.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$527.03
|
| Rate for Payer: Healthscope Whirlpool |
$511.22
|
| Rate for Payer: Mclaren Commercial |
$474.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.79
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
IP
|
$1,195.03
|
|
|
Service Code
|
NDC 0456-1120-30
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$836.52 |
| Max. Negotiated Rate |
$1,195.03 |
| Rate for Payer: Aetna Commercial |
$1,075.53
|
| Rate for Payer: ASR ASR |
$1,159.18
|
| Rate for Payer: BCBS Trust/PPO |
$926.51
|
| Rate for Payer: BCN Commercial |
$926.51
|
| Rate for Payer: Cash Price |
$956.02
|
| Rate for Payer: Cofinity Commercial |
$1,123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.02
|
| Rate for Payer: Healthscope Commercial |
$1,195.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.18
|
| Rate for Payer: Mclaren Commercial |
$1,075.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.63
|
|
|
VILAZODONE 40 MG TABLET
|
Facility
IP
|
$156.38
|
|
|
Service Code
|
NDC 62332-234-30
|
| Hospital Charge Code |
152701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: BCBS Trust/PPO |
$121.24
|
| Rate for Payer: BCN Commercial |
$121.24
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Healthscope Whirlpool |
$151.69
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.61
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
IP
|
$21,056.32
|
|
|
Service Code
|
MS-DRG 865
|
| Min. Negotiated Rate |
$14,786.74 |
| Max. Negotiated Rate |
$21,056.32 |
| Rate for Payer: Aetna Medicare |
$15,564.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,456.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,456.24
|
| Rate for Payer: BCBS MAPPO |
$15,564.99
|
| Rate for Payer: BCN Medicare Advantage |
$15,564.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,564.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,564.99
|
| Rate for Payer: Mclaren Medicare |
$15,564.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,343.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,899.74
|
| Rate for Payer: PACE Medicare |
$14,786.74
|
| Rate for Payer: PACE SWMI |
$15,564.99
|
| Rate for Payer: PHP Commercial |
$17,121.49
|
| Rate for Payer: PHP Medicare Advantage |
$15,564.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,056.32
|
| Rate for Payer: Priority Health Medicare |
$15,564.99
|
| Rate for Payer: Priority Health Narrow Network |
$16,845.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15,564.99
|
| Rate for Payer: UHC Medicare Advantage |
$16,031.94
|
| Rate for Payer: VA VA |
$15,564.99
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
IP
|
$11,813.19
|
|
|
Service Code
|
MS-DRG 866
|
| Min. Negotiated Rate |
$8,978.02 |
| Max. Negotiated Rate |
$11,813.19 |
| Rate for Payer: Aetna Medicare |
$9,450.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,813.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,813.19
|
| Rate for Payer: BCBS MAPPO |
$9,450.55
|
| Rate for Payer: BCN Medicare Advantage |
$9,450.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,450.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,450.55
|
| Rate for Payer: Mclaren Medicare |
$9,450.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,923.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,868.13
|
| Rate for Payer: PACE Medicare |
$8,978.02
|
| Rate for Payer: PACE SWMI |
$9,450.55
|
| Rate for Payer: PHP Commercial |
$10,395.60
|
| Rate for Payer: PHP Medicare Advantage |
$9,450.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,783.27
|
| Rate for Payer: Priority Health Medicare |
$9,450.55
|
| Rate for Payer: Priority Health Narrow Network |
$9,426.62
|
| Rate for Payer: Railroad Medicare Medicare |
$9,450.55
|
| Rate for Payer: UHC Medicare Advantage |
$9,734.07
|
| Rate for Payer: VA VA |
$9,450.55
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
IP
|
$24,573.19
|
|
|
Service Code
|
MS-DRG 075
|
| Min. Negotiated Rate |
$16,989.73 |
| Max. Negotiated Rate |
$24,573.19 |
| Rate for Payer: Aetna Medicare |
$17,883.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,354.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,354.91
|
| Rate for Payer: BCBS MAPPO |
$17,883.93
|
| Rate for Payer: BCN Medicare Advantage |
$17,883.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,883.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,883.93
|
| Rate for Payer: Mclaren Medicare |
$17,883.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,778.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,566.52
|
| Rate for Payer: PACE Medicare |
$16,989.73
|
| Rate for Payer: PACE SWMI |
$17,883.93
|
| Rate for Payer: PHP Commercial |
$19,672.32
|
| Rate for Payer: PHP Medicare Advantage |
$17,883.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,573.19
|
| Rate for Payer: Priority Health Medicare |
$17,883.93
|
| Rate for Payer: Priority Health Narrow Network |
$19,658.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17,883.93
|
| Rate for Payer: UHC Medicare Advantage |
$18,420.45
|
| Rate for Payer: VA VA |
$17,883.93
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
IP
|
$11,863.99
|
|
|
Service Code
|
MS-DRG 076
|
| Min. Negotiated Rate |
$9,016.63 |
| Max. Negotiated Rate |
$11,863.99 |
| Rate for Payer: Aetna Medicare |
$9,491.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,863.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,863.99
|
| Rate for Payer: BCBS MAPPO |
$9,491.19
|
| Rate for Payer: BCN Medicare Advantage |
$9,491.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,491.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,491.19
|
| Rate for Payer: Mclaren Medicare |
$9,491.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,965.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,914.87
|
| Rate for Payer: PACE Medicare |
$9,016.63
|
| Rate for Payer: PACE SWMI |
$9,491.19
|
| Rate for Payer: PHP Commercial |
$10,440.31
|
| Rate for Payer: PHP Medicare Advantage |
$9,491.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,844.90
|
| Rate for Payer: Priority Health Medicare |
$9,491.19
|
| Rate for Payer: Priority Health Narrow Network |
$9,475.92
|
| Rate for Payer: Railroad Medicare Medicare |
$9,491.19
|
| Rate for Payer: UHC Medicare Advantage |
$9,775.93
|
| Rate for Payer: VA VA |
$9,491.19
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
IP
|
$15.30
|
|
|
Service Code
|
NDC 61924-204-04
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
VITAMIN B COMPLEX CAPSULE
|
Facility
IP
|
$169.20
|
|
|
Service Code
|
NDC 536478701
|
| Hospital Charge Code |
804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$152.28
|
| Rate for Payer: ASR ASR |
$164.12
|
| Rate for Payer: BCBS Trust/PPO |
$131.18
|
| Rate for Payer: BCN Commercial |
$131.18
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$159.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Healthscope Whirlpool |
$164.12
|
| Rate for Payer: Mclaren Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.90
|
|
|
VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT
|
Facility
IP
|
$12.62
|
|
|
Service Code
|
NDC 4110081163
|
| Hospital Charge Code |
118725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: ASR ASR |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.78
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$12.62
|
| Rate for Payer: Healthscope Whirlpool |
$12.24
|
| Rate for Payer: Mclaren Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.11
|
|
|
VIVONEX RTF BOLUS FEED
|
Facility
IP
|
$14.80
|
|
|
Service Code
|
NDC 4390036250
|
| Hospital Charge Code |
150771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
VIVONEX RTF CONTINUOUS FEED
|
Facility
IP
|
$6,408.40
|
|
|
Service Code
|
NDC 9900-0005-76
|
| Hospital Charge Code |
168947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,485.88 |
| Max. Negotiated Rate |
$6,408.40 |
| Rate for Payer: Aetna Commercial |
$5,767.56
|
| Rate for Payer: ASR ASR |
$6,216.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,968.43
|
| Rate for Payer: BCN Commercial |
$4,968.43
|
| Rate for Payer: Cash Price |
$5,126.72
|
| Rate for Payer: Cofinity Commercial |
$6,023.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,126.72
|
| Rate for Payer: Healthscope Commercial |
$6,408.40
|
| Rate for Payer: Healthscope Whirlpool |
$6,216.15
|
| Rate for Payer: Mclaren Commercial |
$5,767.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,447.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,485.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,639.39
|
|
