|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,846.25
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$13,042.94 |
| Max. Negotiated Rate |
$22,846.25 |
| Rate for Payer: Aetna Medicare |
$13,729.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,161.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,161.76
|
| Rate for Payer: BCBS MAPPO |
$13,729.41
|
| Rate for Payer: BCN Medicare Advantage |
$13,729.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,729.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,729.41
|
| Rate for Payer: Mclaren Medicare |
$13,729.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,415.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,788.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,102.35
|
| Rate for Payer: PACE Medicare |
$13,042.94
|
| Rate for Payer: PACE SWMI |
$13,729.41
|
| Rate for Payer: PHP Commercial |
$15,102.35
|
| Rate for Payer: PHP Medicare Advantage |
$13,729.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,846.25
|
| Rate for Payer: Priority Health Medicare |
$13,729.41
|
| Rate for Payer: Priority Health Narrow Network |
$18,277.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13,729.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,729.41
|
| Rate for Payer: UHC Exchange |
$21,280.59
|
| Rate for Payer: UHCCP DNSP |
$13,729.41
|
| Rate for Payer: VA VA |
$13,729.41
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 70710164307
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: ASR ASR |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$15.89
|
| Rate for Payer: Healthscope Whirlpool |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.42
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 70710164301
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| 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 |
$20.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.62
|
|
|
Service Code
|
NDC 70756060582
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Medicare |
$6.89
|
| Rate for Payer: ASR ASR |
$18.06
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$15.35
|
| Rate for Payer: BCN Commercial |
$15.35
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.06
|
| Rate for Payer: Healthscope Whirlpool |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.31
|
| Rate for Payer: Priority Health Narrow Network |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.38
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
NDC 409114405
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: ASR ASR |
$26.02
|
| Rate for Payer: BCBS Trust/PPO |
$22.03
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.02
|
| Rate for Payer: Healthscope Whirlpool |
$26.82
|
| Rate for Payer: Mclaren Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.80
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.94
|
|
|
Service Code
|
NDC 67850007100
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: ASR ASR |
$18.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.56
|
| Rate for Payer: BCN Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$18.38
|
| Rate for Payer: Healthscope Whirlpool |
$18.94
|
| Rate for Payer: Mclaren Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.67
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.62
|
|
|
Service Code
|
NDC 70756060582
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: ASR ASR |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$15.29
|
| Rate for Payer: BCN Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.06
|
| Rate for Payer: Healthscope Whirlpool |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.38
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.94
|
|
|
Service Code
|
NDC 67850007100
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: ASR ASR |
$18.38
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.62
|
| Rate for Payer: BCN Commercial |
$15.62
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$18.38
|
| Rate for Payer: Healthscope Whirlpool |
$18.94
|
| Rate for Payer: Mclaren Commercial |
$17.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.10
|
| Rate for Payer: Nomi Health Commercial |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.60
|
| Rate for Payer: Priority Health Narrow Network |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.67
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
NDC 409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Medicare |
$103.97
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.69
|
| Rate for Payer: BCN Commercial |
$231.69
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$272.57
|
| Rate for Payer: Healthscope Whirlpool |
$281.00
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$246.22
|
| Rate for Payer: Priority Health Narrow Network |
$196.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710164301
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCN Commercial |
$17.64
|
| 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 |
$20.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$19.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
NDC 67850007125
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.98
|
| Rate for Payer: BCN Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Mclaren Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$16.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.19
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.79
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: ASR ASR |
$17.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.23
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.79
|
| Rate for Payer: Mclaren Commercial |
$16.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.12
|
| Rate for Payer: Nomi Health Commercial |
$14.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.66
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
NDC 409114405
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: Aetna Medicare |
$9.93
|
| Rate for Payer: ASR ASR |
$26.02
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: BCBS Trust/PPO |
$22.12
|
| Rate for Payer: BCN Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.02
|
| Rate for Payer: Healthscope Whirlpool |
$26.82
|
| Rate for Payer: Mclaren Commercial |
$24.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.80
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.50
|
| Rate for Payer: Priority Health Narrow Network |
$18.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.79
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: ASR ASR |
$17.26
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS Trust/PPO |
$14.67
|
| Rate for Payer: BCN Commercial |
$14.67
|
| Rate for Payer: Cash Price |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.23
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Whirlpool |
$17.79
|
| Rate for Payer: Mclaren Commercial |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.12
|
| Rate for Payer: Nomi Health Commercial |
$14.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.59
|
| Rate for Payer: Priority Health Narrow Network |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.66
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
NDC 409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Trust/PPO |
$230.76
|
| Rate for Payer: BCN Commercial |
$230.76
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$272.57
|
| Rate for Payer: Healthscope Whirlpool |
$281.00
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 70710164307
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: ASR ASR |
$15.89
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$15.89
|
| Rate for Payer: Healthscope Whirlpool |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Narrow Network |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.42
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
NDC 67850007125
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$18.61
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: ASR ASR |
$20.06
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.68
|
| Rate for Payer: Mclaren Commercial |
$18.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$16.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.19
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: ASR ASR |
$11.79
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$10.03
|
| Rate for Payer: BCN Commercial |
$10.03
|
| 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 |
$11.79
|
| Rate for Payer: Healthscope Whirlpool |
$12.16
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow Network |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: ASR ASR |
$11.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.98
|
| Rate for Payer: BCN Commercial |
$9.98
|
| 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 |
$11.79
|
| Rate for Payer: Healthscope Whirlpool |
$12.16
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.33
|
| Rate for Payer: BCN Commercial |
$4.33
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.09
|
| Rate for Payer: Healthscope Whirlpool |
$5.25
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.60
|
| Rate for Payer: Priority Health Narrow Network |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.48 |
| 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 |
$430.83
|
| Rate for Payer: BCN Commercial |
$430.83
|
| 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 |
$508.90
|
| Rate for Payer: Healthscope Whirlpool |
$524.64
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: Aetna Medicare |
$75.92
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS Trust/PPO |
$169.19
|
| Rate for Payer: BCN Commercial |
$169.19
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Healthscope Whirlpool |
$205.20
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.80
|
| Rate for Payer: Priority Health Narrow Network |
$143.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: Aetna Medicare |
$194.12
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: BCBS Trust/PPO |
$432.57
|
| Rate for Payer: BCN Commercial |
$432.57
|
| 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 |
$508.90
|
| Rate for Payer: Healthscope Whirlpool |
$524.64
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.69
|
| Rate for Payer: Priority Health Narrow Network |
$367.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$184.68
|
| Rate for Payer: ASR ASR |
$199.04
|
| Rate for Payer: BCBS Trust/PPO |
$168.51
|
| Rate for Payer: BCN Commercial |
$168.51
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$192.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Healthscope Whirlpool |
$205.20
|
| Rate for Payer: Mclaren Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.58
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| 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 |
$4.31
|
| Rate for Payer: BCN Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.09
|
| Rate for Payer: Healthscope Whirlpool |
$5.25
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
