|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: Aetna Medicare |
$115.64
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$257.70
|
| Rate for Payer: BCN Commercial |
$257.70
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$303.17
|
| Rate for Payer: Healthscope Whirlpool |
$312.55
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$273.86
|
| Rate for Payer: Priority Health Narrow Network |
$219.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$173.43
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.07 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna Commercial |
$156.09
|
| Rate for Payer: ASR ASR |
$168.23
|
| Rate for Payer: BCBS Trust/PPO |
$142.42
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cofinity Commercial |
$163.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.74
|
| Rate for Payer: Healthscope Commercial |
$168.23
|
| Rate for Payer: Healthscope Whirlpool |
$173.43
|
| Rate for Payer: Mclaren Commercial |
$156.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.42
|
| Rate for Payer: Nomi Health Commercial |
$142.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.62
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.41 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: BCBS Trust/PPO |
$256.67
|
| Rate for Payer: BCN Commercial |
$256.67
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$303.17
|
| Rate for Payer: Healthscope Whirlpool |
$312.55
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$252.29
|
| Rate for Payer: ASR ASR |
$271.91
|
| Rate for Payer: BCBS Trust/PPO |
$230.20
|
| Rate for Payer: BCN Commercial |
$230.20
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$271.91
|
| Rate for Payer: Healthscope Whirlpool |
$280.32
|
| Rate for Payer: Mclaren Commercial |
$252.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.68
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$222.08
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$199.87
|
| Rate for Payer: ASR ASR |
$215.41
|
| Rate for Payer: BCBS Trust/PPO |
$182.37
|
| Rate for Payer: BCN Commercial |
$182.37
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$208.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$215.41
|
| Rate for Payer: Healthscope Whirlpool |
$222.07
|
| Rate for Payer: Mclaren Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.76
|
| Rate for Payer: Nomi Health Commercial |
$182.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.43
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: ASR ASR |
$2.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.30
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.38
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.47
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$226.58
|
|
|
Service Code
|
NDC 93738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.92
|
| Rate for Payer: Aetna Medicare |
$83.83
|
| Rate for Payer: ASR ASR |
$219.78
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$186.81
|
| Rate for Payer: BCN Commercial |
$186.81
|
| 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 |
$219.78
|
| Rate for Payer: Healthscope Whirlpool |
$226.57
|
| Rate for Payer: Mclaren Commercial |
$203.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.59
|
| Rate for Payer: Nomi Health Commercial |
$185.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.53
|
| Rate for Payer: Priority Health Narrow Network |
$158.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.39
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$226.58
|
|
|
Service Code
|
NDC 93738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.92
|
| Rate for Payer: ASR ASR |
$219.78
|
| Rate for Payer: BCBS Trust/PPO |
$186.06
|
| Rate for Payer: BCN Commercial |
$186.06
|
| 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 |
$219.78
|
| Rate for Payer: Healthscope Whirlpool |
$226.57
|
| Rate for Payer: Mclaren Commercial |
$203.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.59
|
| Rate for Payer: Nomi Health Commercial |
$185.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.39
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$222.08
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna Commercial |
$199.87
|
| Rate for Payer: Aetna Medicare |
$82.17
|
| Rate for Payer: ASR ASR |
$215.41
|
| Rate for Payer: BCBS Complete |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$183.10
|
| Rate for Payer: BCN Commercial |
$183.10
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$208.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$215.41
|
| Rate for Payer: Healthscope Whirlpool |
$222.07
|
| Rate for Payer: Mclaren Commercial |
$199.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.76
|
| Rate for Payer: Nomi Health Commercial |
$182.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.58
|
| Rate for Payer: Priority Health Narrow Network |
$155.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.43
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.57 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: BCBS Trust/PPO |
$248.08
|
| Rate for Payer: BCN Commercial |
$248.08
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$293.04
|
| Rate for Payer: Healthscope Whirlpool |
$302.10
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$252.29
|
| Rate for Payer: Aetna Medicare |
$103.72
|
| Rate for Payer: ASR ASR |
$271.91
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: BCBS Trust/PPO |
$231.12
|
| Rate for Payer: BCN Commercial |
$231.12
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$271.91
|
| Rate for Payer: Healthscope Whirlpool |
$280.32
|
| Rate for Payer: Mclaren Commercial |
$252.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.62
|
| Rate for Payer: Priority Health Narrow Network |
$196.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.68
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: Aetna Medicare |
$111.78
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.08
|
| Rate for Payer: BCN Commercial |
$249.08
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$293.04
|
| Rate for Payer: Healthscope Whirlpool |
$302.10
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$264.70
|
| Rate for Payer: Priority Health Narrow Network |
$211.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
NDC 173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.49 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: Aetna Medicare |
$64.49
|
| Rate for Payer: ASR ASR |
$169.07
|
| Rate for Payer: BCBS Complete |
$69.72
|
| Rate for Payer: BCBS Trust/PPO |
$143.71
|
| Rate for Payer: BCN Commercial |
$143.71
|
| 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 |
$169.07
|
| Rate for Payer: Healthscope Whirlpool |
$174.30
|
| Rate for Payer: Mclaren Commercial |
$156.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.16
|
| Rate for Payer: Nomi Health Commercial |
$142.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.72
|
| Rate for Payer: Priority Health Narrow Network |
$122.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.38
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$66.78
|
|
|
Service Code
|
NDC 173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Aetna Medicare |
$24.71
|
| Rate for Payer: ASR ASR |
$64.78
|
| Rate for Payer: BCBS Complete |
$26.71
|
| Rate for Payer: BCBS Trust/PPO |
$55.06
|
| Rate for Payer: BCN Commercial |
$55.06
|
| 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 |
$64.78
|
| Rate for Payer: Healthscope Whirlpool |
$66.78
|
| Rate for Payer: Mclaren Commercial |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.51
|
| Rate for Payer: Priority Health Narrow Network |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.77
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$49.70
|
|
|
Service Code
|
NDC 54074287
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$49.70 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: ASR ASR |
$48.21
|
| Rate for Payer: BCBS Complete |
$19.88
|
| Rate for Payer: BCBS Trust/PPO |
$40.98
|
| Rate for Payer: BCN Commercial |
$40.98
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cofinity Commercial |
$46.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.76
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: Healthscope Whirlpool |
$49.70
|
| Rate for Payer: Mclaren Commercial |
$44.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.24
|
| Rate for Payer: Nomi Health Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.55
|
| Rate for Payer: Priority Health Narrow Network |
$34.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.74
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$49.70
|
|
|
Service Code
|
NDC 54074287
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$49.70 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: ASR ASR |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$40.81
|
| Rate for Payer: BCN Commercial |
$40.81
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cofinity Commercial |
$46.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.76
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: Healthscope Whirlpool |
$49.70
|
| Rate for Payer: Mclaren Commercial |
$44.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.24
|
| Rate for Payer: Nomi Health Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.74
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$66.78
|
|
|
Service Code
|
NDC 173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.09 |
| 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 |
$54.84
|
| Rate for Payer: BCN Commercial |
$54.84
|
| 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 |
$64.78
|
| Rate for Payer: Healthscope Whirlpool |
$66.78
|
| Rate for Payer: Mclaren Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.09
|
| 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 173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.72 |
| 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 |
$143.14
|
| Rate for Payer: BCN Commercial |
$143.14
|
| 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 |
$169.07
|
| Rate for Payer: Healthscope Whirlpool |
$174.30
|
| Rate for Payer: Mclaren Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.16
|
| Rate for Payer: Nomi Health Commercial |
$142.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.38
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$9,078.32
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$8,207.89 |
| Max. Negotiated Rate |
$9,078.32 |
| Rate for Payer: BCBS Complete |
$9,078.32
|
| Rate for Payer: Mclaren Medicaid |
$8,646.02
|
| Rate for Payer: Meridian Medicaid |
$9,078.32
|
| Rate for Payer: PHP Medicaid |
$8,207.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,646.02
|
| Rate for Payer: UHC Medicaid |
$8,646.02
|
| Rate for Payer: UHCCP Medicaid |
$8,646.02
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$22,826.87
|
|
|
Service Code
|
APR-DRG 0224
|
| Min. Negotiated Rate |
$20,638.22 |
| Max. Negotiated Rate |
$22,826.87 |
| Rate for Payer: BCBS Complete |
$22,826.87
|
| Rate for Payer: Mclaren Medicaid |
$21,739.87
|
| Rate for Payer: Meridian Medicaid |
$22,826.87
|
| Rate for Payer: PHP Medicaid |
$20,638.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,739.87
|
| Rate for Payer: UHC Medicaid |
$21,739.87
|
| Rate for Payer: UHCCP Medicaid |
$21,739.87
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$8,485.42
|
|
|
Service Code
|
APR-DRG 0222
|
| Min. Negotiated Rate |
$7,671.83 |
| Max. Negotiated Rate |
$8,485.42 |
| Rate for Payer: BCBS Complete |
$8,485.42
|
| Rate for Payer: Mclaren Medicaid |
$8,081.35
|
| Rate for Payer: Meridian Medicaid |
$8,485.42
|
| Rate for Payer: PHP Medicaid |
$7,671.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,081.35
|
| Rate for Payer: UHC Medicaid |
$8,081.35
|
| Rate for Payer: UHCCP Medicaid |
$8,081.35
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$8,403.13
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$7,597.43 |
| Max. Negotiated Rate |
$8,403.13 |
| Rate for Payer: BCBS Complete |
$8,403.13
|
| Rate for Payer: Mclaren Medicaid |
$8,002.98
|
| Rate for Payer: Meridian Medicaid |
$8,403.13
|
| Rate for Payer: PHP Medicaid |
$7,597.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,002.98
|
| Rate for Payer: UHC Medicaid |
$8,002.98
|
| Rate for Payer: UHCCP Medicaid |
$8,002.98
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$29,277.38
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$16,245.29 |
| Max. Negotiated Rate |
$29,277.38 |
| Rate for Payer: Aetna Medicare |
$17,100.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,375.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,375.39
|
| Rate for Payer: BCBS MAPPO |
$17,100.31
|
| Rate for Payer: BCN Medicare Advantage |
$17,100.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,100.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,100.31
|
| Rate for Payer: Mclaren Medicare |
$17,100.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,955.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,665.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,810.34
|
| Rate for Payer: PACE Medicare |
$16,245.29
|
| Rate for Payer: PACE SWMI |
$17,100.31
|
| Rate for Payer: PHP Commercial |
$18,810.34
|
| Rate for Payer: PHP Medicare Advantage |
$17,100.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,277.38
|
| Rate for Payer: Priority Health Medicare |
$17,100.31
|
| Rate for Payer: Priority Health Narrow Network |
$23,421.91
|
| Rate for Payer: Railroad Medicare Medicare |
$17,100.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,100.31
|
| Rate for Payer: UHC Exchange |
$26,505.48
|
| Rate for Payer: UHCCP DNSP |
$17,100.31
|
| Rate for Payer: VA VA |
$17,100.31
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$61,556.69
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$32,318.65 |
| Max. Negotiated Rate |
$61,556.69 |
| Rate for Payer: Aetna Medicare |
$34,019.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,524.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,524.54
|
| Rate for Payer: BCBS MAPPO |
$34,019.63
|
| Rate for Payer: BCN Medicare Advantage |
$34,019.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,019.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,019.63
|
| Rate for Payer: Mclaren Medicare |
$34,019.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35,720.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,122.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,421.59
|
| Rate for Payer: PACE Medicare |
$32,318.65
|
| Rate for Payer: PACE SWMI |
$34,019.63
|
| Rate for Payer: PHP Commercial |
$37,421.59
|
| Rate for Payer: PHP Medicare Advantage |
$34,019.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61,556.69
|
| Rate for Payer: Priority Health Medicare |
$34,019.63
|
| Rate for Payer: Priority Health Narrow Network |
$49,245.35
|
| Rate for Payer: Railroad Medicare Medicare |
$34,019.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,019.63
|
| Rate for Payer: UHC Exchange |
$52,730.43
|
| Rate for Payer: UHCCP DNSP |
$34,019.63
|
| Rate for Payer: VA VA |
$34,019.63
|
|
