|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$358.15
|
|
|
Service Code
|
NDC 00904707661
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.75 |
| Max. Negotiated Rate |
$322.33 |
| Rate for Payer: Aetna Commercial |
$304.43
|
| Rate for Payer: Aetna Medicare |
$179.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.80
|
| Rate for Payer: BCBS Complete |
$143.26
|
| 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: MI Amish Medical Board Commercial |
$286.52
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.80
|
| Rate for Payer: UHC Core |
$186.60
|
| Rate for Payer: UHC Exchange |
$140.75
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$173.43
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: Aetna Medicare |
$86.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.73
|
| Rate for Payer: BCBS Complete |
$69.37
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cofinity Advantage |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$149.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.74
|
| Rate for Payer: Healthscope Commercial |
$156.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.07
|
| Rate for Payer: PHP Commercial |
$147.42
|
| Rate for Payer: Priority Health SBD |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.73
|
| Rate for Payer: UHC Core |
$90.36
|
| Rate for Payer: UHC Exchange |
$68.16
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$71.21
|
|
|
Service Code
|
NDC 65862052730
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$64.09 |
| Rate for Payer: Aetna Commercial |
$60.53
|
| Rate for Payer: Aetna Medicare |
$35.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.29
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cofinity Advantage |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$61.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.97
|
| Rate for Payer: Healthscope Commercial |
$64.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.41
|
| Rate for Payer: PHP Commercial |
$60.53
|
| Rate for Payer: Priority Health SBD |
$44.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.29
|
| Rate for Payer: UHC Core |
$37.10
|
| Rate for Payer: UHC Exchange |
$27.99
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: UHC Exchange |
$1.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$71.21
|
|
|
Service Code
|
NDC 65862052730
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$64.09 |
| Rate for Payer: Aetna Commercial |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.29
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cofinity Advantage |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$61.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.97
|
| Rate for Payer: Healthscope Commercial |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.41
|
| Rate for Payer: PHP Commercial |
$60.53
|
| Rate for Payer: Priority Health SBD |
$44.86
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health SBD |
$1.67
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$264.48
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna Commercial |
$224.81
|
| Rate for Payer: Aetna Medicare |
$132.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.91
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cofinity Advantage |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$227.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.58
|
| Rate for Payer: Healthscope Commercial |
$238.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.36
|
| Rate for Payer: PHP Commercial |
$224.81
|
| Rate for Payer: Priority Health SBD |
$166.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.91
|
| Rate for Payer: UHC Core |
$137.79
|
| Rate for Payer: UHC Exchange |
$103.94
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$264.48
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.62 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna Commercial |
$224.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.91
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cofinity Advantage |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$227.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.58
|
| Rate for Payer: Healthscope Commercial |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.36
|
| Rate for Payer: PHP Commercial |
$224.81
|
| Rate for Payer: Priority Health SBD |
$166.62
|
|
|
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 |
$109.26 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.73
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cofinity Advantage |
$121.40
|
| Rate for Payer: Cofinity Commercial |
$149.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.74
|
| Rate for Payer: Healthscope Commercial |
$156.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.07
|
| Rate for Payer: PHP Commercial |
$147.42
|
| Rate for Payer: Priority Health SBD |
$109.26
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$75.44
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.04
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cofinity Advantage |
$52.81
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.35
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health SBD |
$47.53
|
|
|
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 |
$139.91 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.35
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Advantage |
$155.46
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: Priority Health SBD |
$139.91
|
|
|
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 |
$110.17 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$140.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.21
|
| Rate for Payer: UHC Core |
$146.05
|
| Rate for Payer: UHC Exchange |
$110.17
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$226.58
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna Medicare |
$113.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Advantage |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$169.94
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.28
|
| Rate for Payer: UHC Core |
$118.05
|
| Rate for Payer: UHC Exchange |
$89.05
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: Priority Health SBD |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.10
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$226.58
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Advantage |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$203.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.94
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health SBD |
$142.75
|
|
|
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 |
$176.60 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$75.44
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.04
|
| Rate for Payer: BCBS Complete |
$30.18
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cofinity Advantage |
$52.81
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.35
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health SBD |
$47.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.04
|
| Rate for Payer: UHC Core |
$39.30
|
| Rate for Payer: UHC Exchange |
$29.65
|
|
|
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 |
$87.28 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna Medicare |
$111.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.35
|
| Rate for Payer: BCBS Complete |
$88.83
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Advantage |
$155.46
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$199.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: Priority Health SBD |
$139.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.35
|
| Rate for Payer: UHC Core |
$115.70
|
| Rate for Payer: UHC Exchange |
$87.28
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: Priority Health SBD |
$1.77
|
|
|
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 69424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,345.73
|
| Rate for Payer: BCN Commercial |
$2,345.73
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
NDC 00173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Aetna Commercial |
$148.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.30
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Advantage |
$122.01
|
| Rate for Payer: Cofinity Commercial |
$149.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.44
|
| Rate for Payer: Healthscope Commercial |
$156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.72
|
| Rate for Payer: PHP Commercial |
$148.16
|
| Rate for Payer: Priority Health SBD |
$109.81
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$102.90
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.89
|
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Cofinity Advantage |
$72.03
|
| Rate for Payer: Cofinity Commercial |
$88.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.32
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.17
|
| Rate for Payer: PHP Commercial |
$87.47
|
| Rate for Payer: Priority Health SBD |
$64.83
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
NDC 00173068220
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.50 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Aetna Commercial |
$148.16
|
| Rate for Payer: Aetna Medicare |
$87.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.30
|
| Rate for Payer: BCBS Complete |
$69.72
|
| Rate for Payer: Cash Price |
$139.44
|
| Rate for Payer: Cofinity Advantage |
$122.01
|
| Rate for Payer: Cofinity Commercial |
$149.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.44
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$130.72
|
| Rate for Payer: PHP Commercial |
$148.16
|
| Rate for Payer: Priority Health SBD |
$109.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.30
|
| Rate for Payer: UHC Core |
$90.81
|
| Rate for Payer: UHC Exchange |
$68.50
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$66.78
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna Medicare |
$33.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: BCBS Complete |
$26.71
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Advantage |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope 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: Opus (Opus Packaging Group) HMA |
$50.09
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health SBD |
$42.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.41
|
| Rate for Payer: UHC Core |
$34.79
|
| Rate for Payer: UHC Exchange |
$26.24
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$66.78
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Advantage |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.09
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health SBD |
$42.07
|
|
