|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$178.64
|
|
|
Service Code
|
HCPCS J2596
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Aetna Commercial |
$151.84
|
| Rate for Payer: Aetna Medicare |
$89.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.12
|
| Rate for Payer: BCBS Complete |
$71.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.48
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$142.91
|
| Rate for Payer: Cash Price |
$142.91
|
| Rate for Payer: Cofinity Advantage |
$125.05
|
| Rate for Payer: Cofinity Commercial |
$153.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.91
|
| Rate for Payer: Healthscope Commercial |
$160.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.98
|
| Rate for Payer: PHP Commercial |
$151.84
|
| Rate for Payer: Priority Health SBD |
$112.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.95
|
| Rate for Payer: UHC Exchange |
$2.95
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$178.64
|
|
|
Service Code
|
HCPCS J2596
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.54 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Aetna Commercial |
$151.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.12
|
| Rate for Payer: Cash Price |
$142.91
|
| Rate for Payer: Cofinity Advantage |
$125.05
|
| Rate for Payer: Cofinity Commercial |
$153.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.91
|
| Rate for Payer: Healthscope Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.98
|
| Rate for Payer: PHP Commercial |
$151.84
|
| Rate for Payer: Priority Health SBD |
$112.54
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$330.84
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$297.76 |
| Rate for Payer: Aetna Commercial |
$281.21
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.91
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.53
|
| Rate for Payer: Cash Price |
$264.67
|
| Rate for Payer: Cash Price |
$264.67
|
| Rate for Payer: Cofinity Advantage |
$231.59
|
| Rate for Payer: Cofinity Commercial |
$284.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$297.76
|
| Rate for Payer: Mclaren Medicaid |
$0.80
|
| Rate for Payer: Mclaren Medicare |
$1.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.61
|
| Rate for Payer: Meridian Medicaid |
$1.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.21
|
| Rate for Payer: Nomi Health Commercial |
$4.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.13
|
| Rate for Payer: PACE Medicare |
$1.45
|
| Rate for Payer: PACE SWMI |
$1.53
|
| Rate for Payer: PHP Commercial |
$281.21
|
| Rate for Payer: PHP Medicare Advantage |
$1.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.34
|
| Rate for Payer: Priority Health Medicare |
$1.53
|
| Rate for Payer: Priority Health SBD |
$208.43
|
| Rate for Payer: Priority Health Tiered Network |
$5.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.53
|
| Rate for Payer: UHC Exchange |
$3.66
|
| Rate for Payer: UHC Medicaid |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.80
|
| Rate for Payer: VA VA |
$1.53
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26,282.62
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$23,654.36 |
| Rate for Payer: Aetna Commercial |
$22,340.23
|
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,083.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.23
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS MAPPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$53.61
|
| Rate for Payer: BCN Commercial |
$53.61
|
| Rate for Payer: BCN Medicare Advantage |
$20.98
|
| Rate for Payer: Cash Price |
$21,026.10
|
| Rate for Payer: Cash Price |
$21,026.10
|
| Rate for Payer: Cofinity Advantage |
$18,397.83
|
| Rate for Payer: Cofinity Commercial |
$22,603.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,026.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.98
|
| Rate for Payer: Healthscope Commercial |
$23,654.36
|
| Rate for Payer: Mclaren Medicaid |
$10.97
|
| Rate for Payer: Mclaren Medicare |
$20.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.03
|
| Rate for Payer: Meridian Medicaid |
$22.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,340.23
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,711.97
|
| Rate for Payer: PACE Medicare |
$19.93
|
| Rate for Payer: PACE SWMI |
$20.98
|
| Rate for Payer: PHP Commercial |
$22,340.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.21
|
| Rate for Payer: Priority Health Medicare |
$20.98
|
| Rate for Payer: Priority Health SBD |
$16,558.05
|
| Rate for Payer: Priority Health Tiered Network |
$53.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$35.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.98
|
| Rate for Payer: UHC Exchange |
$35.26
|
| Rate for Payer: UHC Medicaid |
$10.97
|
| Rate for Payer: UHCCP Medicaid |
$10.97
|
| Rate for Payer: VA VA |
$20.98
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26,282.62
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,558.05 |
| Max. Negotiated Rate |
$23,654.36 |
| Rate for Payer: Aetna Commercial |
$22,340.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,083.70
|
| Rate for Payer: Cash Price |
$21,026.10
|
| Rate for Payer: Cofinity Advantage |
$18,397.83
|
| Rate for Payer: Cofinity Commercial |
$22,603.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,026.10
|
| Rate for Payer: Healthscope Commercial |
$23,654.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,340.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,711.97
|
| Rate for Payer: PHP Commercial |
$22,340.23
|
| Rate for Payer: Priority Health SBD |
$16,558.05
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$53,592.62
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$22,996.92 |
| Max. Negotiated Rate |
$53,592.62 |
| Rate for Payer: Aetna Medicare |
$25,175.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,259.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,259.10
|
| Rate for Payer: BCBS MAPPO |
$24,207.28
|
| Rate for Payer: BCBS Trust/PPO |
$53,592.62
|
| Rate for Payer: BCN Commercial |
$53,592.62
|
| Rate for Payer: BCN Medicare Advantage |
$24,207.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,207.28
|
| Rate for Payer: Mclaren Medicare |
$24,207.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,417.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,838.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,628.01
|
| Rate for Payer: Nomi Health Commercial |
$39,440.46
|
| Rate for Payer: PACE Medicare |
$22,996.92
|
| Rate for Payer: PACE SWMI |
$24,207.28
|
| Rate for Payer: PHP Medicare Advantage |
$24,207.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49,291.83
|
| Rate for Payer: Priority Health Medicare |
$24,207.28
|
| Rate for Payer: Priority Health Tiered Network |
$39,433.46
|
| Rate for Payer: Railroad Medicare Medicare |
$24,207.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,835.62
|
| Rate for Payer: UHC Core |
$41,693.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,207.28
|
| Rate for Payer: UHC Exchange |
$34,050.26
|
| Rate for Payer: VA VA |
$24,207.28
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
IP
|
$283.10
|
|
|
Service Code
|
NDC 57664039288
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.35 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.01
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Advantage |
$198.17
|
| Rate for Payer: Cofinity Commercial |
$243.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$254.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.32
|
| Rate for Payer: PHP Commercial |
$240.63
|
| Rate for Payer: Priority Health SBD |
$178.35
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
OP
|
$283.10
|
|
|
Service Code
|
NDC 57664039288
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: Aetna Medicare |
$141.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.01
|
| Rate for Payer: BCBS Complete |
$113.24
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Advantage |
$198.17
|
| Rate for Payer: Cofinity Commercial |
$243.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$254.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.32
|
| Rate for Payer: PHP Commercial |
$240.63
|
| Rate for Payer: Priority Health SBD |
$178.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.01
|
| Rate for Payer: UHC Core |
$147.50
|
| Rate for Payer: UHC Exchange |
$111.26
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68084089695
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.57
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health SBD |
$3.00
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
IP
|
$142.71
|
|
|
Service Code
|
NDC 68084089625
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.91 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$121.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.76
|
| Rate for Payer: Cash Price |
$114.17
|
| Rate for Payer: Cofinity Advantage |
$99.90
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.17
|
| Rate for Payer: Healthscope Commercial |
$128.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.03
|
| Rate for Payer: PHP Commercial |
$121.30
|
| Rate for Payer: Priority Health SBD |
$89.91
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 68084089695
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.57
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.48
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
|
OP
|
$142.71
|
|
|
Service Code
|
NDC 68084089625
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$121.30
|
| Rate for Payer: Aetna Medicare |
$71.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.76
|
| Rate for Payer: BCBS Complete |
$57.08
|
| Rate for Payer: Cash Price |
$114.17
|
| Rate for Payer: Cofinity Advantage |
$99.90
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.17
|
| Rate for Payer: Healthscope Commercial |
$128.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.03
|
| Rate for Payer: PHP Commercial |
$121.30
|
| Rate for Payer: Priority Health SBD |
$89.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.76
|
| Rate for Payer: UHC Core |
$74.35
|
| Rate for Payer: UHC Exchange |
$56.09
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.86
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Exchange |
$1.73
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 57237017301
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$264.96
|
|
|
Service Code
|
NDC 51079048020
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$238.46 |
| Rate for Payer: Aetna Commercial |
$225.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.22
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Advantage |
$185.47
|
| Rate for Payer: Cofinity Commercial |
$227.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.72
|
| Rate for Payer: PHP Commercial |
$225.22
|
| Rate for Payer: Priority Health SBD |
$166.92
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$439.68
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.79 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna Medicare |
$219.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: BCBS Complete |
$175.87
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Advantage |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.76
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health SBD |
$277.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.79
|
| Rate for Payer: UHC Core |
$229.07
|
| Rate for Payer: UHC Exchange |
$172.79
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$264.96
|
|
|
Service Code
|
NDC 51079048020
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$238.46 |
| Rate for Payer: Aetna Commercial |
$225.22
|
| Rate for Payer: Aetna Medicare |
$132.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.22
|
| Rate for Payer: BCBS Complete |
$105.98
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Advantage |
$185.47
|
| Rate for Payer: Cofinity Commercial |
$227.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$238.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.72
|
| Rate for Payer: PHP Commercial |
$225.22
|
| Rate for Payer: Priority Health SBD |
$166.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$138.04
|
| Rate for Payer: UHC Exchange |
$104.13
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$439.68
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Advantage |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.76
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health SBD |
$277.00
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 57237017301
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$301.44
|
|
|
Service Code
|
NDC 68084071301
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.91 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Advantage |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.08
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health SBD |
$189.91
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
NDC 68084071311
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
NDC 68084071311
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.57
|
| Rate for Payer: UHC Exchange |
$1.19
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$358.15
|
|
|
Service Code
|
NDC 00904707661
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$322.33 |
| Rate for Payer: Aetna Commercial |
$304.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.80
|
| Rate for Payer: Cash Price |
$286.52
|
| Rate for Payer: Cofinity Advantage |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$308.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.52
|
| Rate for Payer: Healthscope Commercial |
$322.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.61
|
| Rate for Payer: PHP Commercial |
$304.43
|
| Rate for Payer: Priority Health SBD |
$225.63
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$301.44
|
|
|
Service Code
|
NDC 68084071301
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: BCBS Complete |
$120.58
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Advantage |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.08
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.94
|
| Rate for Payer: UHC Core |
$157.05
|
| Rate for Payer: UHC Exchange |
$118.47
|
|
