Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION

Facility

$24,335.77

Service Code	HCPCS J3380
Hospital Charge Code	170876
Hospital Revenue Code	636
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$21,902.19
Rate for Payer: Aetna Commercial	$20,685.40
Rate for Payer: Aetna Medicare	$22.16
Rate for Payer: Aetna New Business (MI Preferred)	$15,818.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.64
Rate for Payer: Amish Plain Church Group Commercial	$26.64
Rate for Payer: BCBS Complete	$11.99
Rate for Payer: BCBS MAPPO	$21.31
Rate for Payer: BCN Medicare Advantage	$21.31
Rate for Payer: Cash Price	$19,468.62
Rate for Payer: Cash Price	$19,468.62
Rate for Payer: Cofinity Commercial	$20,928.76
Rate for Payer: Cofinity Commercial	$17,035.04
Rate for Payer: Cofinity Medicare Advantage	$17,035.04
Rate for Payer: Encore Health Key Benefits Commercial	$19,468.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.31
Rate for Payer: Healthscope Commercial	$21,902.19
Rate for Payer: Mclaren Medicaid	$11.42
Rate for Payer: Mclaren Medicare	$21.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$22.38
Rate for Payer: Meridian Medicaid	$11.99
Rate for Payer: MI Amish Medical Board Commercial	$24.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20,685.40
Rate for Payer: PACE Medicare	$20.24
Rate for Payer: PACE SWMI	$21.31
Rate for Payer: PHP Commercial	$20,685.40
Rate for Payer: PHP Medicare Advantage	$21.31
Rate for Payer: Priority Health Choice Medicaid	$11.42
Rate for Payer: Priority Health Cigna Priority Health	$15,818.25
Rate for Payer: Priority Health Medicare	$21.31
Rate for Payer: Priority Health SBD	$15,331.54
Rate for Payer: Railroad Medicare Medicare	$21.31
Rate for Payer: UHC All Payor (Choice/PPO)	$59.99
Rate for Payer: UHC Dual Complete DSNP	$21.31
Rate for Payer: UHC Medicare Advantage	$21.31
Rate for Payer: UHCCP Medicaid	$12.00
Rate for Payer: VA VA	$21.31

VENLAFAXINE 25 MG TABLET

Facility

$121.68

Service Code	NDC 68084089625
Hospital Charge Code	12203
Hospital Revenue Code	637
Min. Negotiated Rate	$76.66
Max. Negotiated Rate	$109.51
Rate for Payer: Aetna Commercial	$103.43
Rate for Payer: Aetna New Business (MI Preferred)	$79.09
Rate for Payer: Cash Price	$97.34
Rate for Payer: Cofinity Commercial	$104.64
Rate for Payer: Cofinity Commercial	$85.18
Rate for Payer: Cofinity Medicare Advantage	$85.18
Rate for Payer: Encore Health Key Benefits Commercial	$97.34
Rate for Payer: Healthscope Commercial	$109.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.43
Rate for Payer: PHP Commercial	$103.43
Rate for Payer: Priority Health Cigna Priority Health	$79.09
Rate for Payer: Priority Health SBD	$76.66

VENLAFAXINE 25 MG TABLET

Facility

$283.10

Service Code	NDC 57664039288
Hospital Charge Code	12203
Hospital Revenue Code	637
Min. Negotiated Rate	$113.24
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 Commercial	$198.17
Rate for Payer: Cofinity Commercial	$243.47
Rate for Payer: Cofinity Medicare Advantage	$198.17
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: PHP Commercial	$240.63
Rate for Payer: Priority Health Cigna Priority Health	$184.01
Rate for Payer: Priority Health SBD	$178.35

VENLAFAXINE 25 MG TABLET

Facility

$121.68

Service Code	NDC 68084089625
Hospital Charge Code	12203
Hospital Revenue Code	637
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$109.51
Rate for Payer: Aetna Commercial	$103.43
Rate for Payer: Aetna Medicare	$60.84
Rate for Payer: Aetna New Business (MI Preferred)	$79.09
Rate for Payer: BCBS Complete	$48.67
Rate for Payer: Cash Price	$97.34
Rate for Payer: Cofinity Commercial	$104.64
Rate for Payer: Cofinity Commercial	$85.18
Rate for Payer: Cofinity Medicare Advantage	$85.18
Rate for Payer: Encore Health Key Benefits Commercial	$97.34
Rate for Payer: Healthscope Commercial	$109.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.43
Rate for Payer: PHP Commercial	$103.43
Rate for Payer: Priority Health Cigna Priority Health	$79.09
Rate for Payer: Priority Health SBD	$76.66

VENLAFAXINE 25 MG TABLET

Facility

$4.06

Service Code	NDC 68084089695
Hospital Charge Code	12203
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna New Business (MI Preferred)	$2.64
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Commercial	$3.49
Rate for Payer: Cofinity Medicare Advantage	$2.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.45
Rate for Payer: PHP Commercial	$3.45
Rate for Payer: Priority Health Cigna Priority Health	$2.64
Rate for Payer: Priority Health SBD	$2.56

VENLAFAXINE 25 MG TABLET

Facility

$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 Commercial	$198.17
Rate for Payer: Cofinity Commercial	$243.47
Rate for Payer: Cofinity Medicare Advantage	$198.17
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: PHP Commercial	$240.63
Rate for Payer: Priority Health Cigna Priority Health	$184.01
Rate for Payer: Priority Health SBD	$178.35

VENLAFAXINE 25 MG TABLET

Facility

$4.06

Service Code	NDC 68084089695
Hospital Charge Code	12203
Hospital Revenue Code	637
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna Medicare	$2.03
Rate for Payer: Aetna New Business (MI Preferred)	$2.64
Rate for Payer: BCBS Complete	$1.62
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Commercial	$3.49
Rate for Payer: Cofinity Medicare Advantage	$2.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.45
Rate for Payer: PHP Commercial	$3.45
Rate for Payer: Priority Health Cigna Priority Health	$2.64
Rate for Payer: Priority Health SBD	$2.56

VENLAFAXINE 37.5 MG TABLET

Facility

$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 Commercial	$185.47
Rate for Payer: Cofinity Commercial	$227.87
Rate for Payer: Cofinity Medicare Advantage	$185.47
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: PHP Commercial	$225.22
Rate for Payer: Priority Health Cigna Priority Health	$172.22
Rate for Payer: Priority Health SBD	$166.92

VENLAFAXINE 37.5 MG TABLET

Facility

$264.96

Service Code	NDC 51079048020
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$105.98
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 Commercial	$185.47
Rate for Payer: Cofinity Commercial	$227.87
Rate for Payer: Cofinity Medicare Advantage	$185.47
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: PHP Commercial	$225.22
Rate for Payer: Priority Health Cigna Priority Health	$172.22
Rate for Payer: Priority Health SBD	$166.92

VENLAFAXINE 37.5 MG TABLET

Facility

$4.24

Service Code	NDC 68084084411
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare	$2.12
Rate for Payer: Aetna New Business (MI Preferred)	$2.76
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.39
Rate for Payer: Cofinity Commercial	$2.97
Rate for Payer: Cofinity Commercial	$3.65
Rate for Payer: Cofinity Medicare Advantage	$2.97
Rate for Payer: Encore Health Key Benefits Commercial	$3.39
Rate for Payer: Healthscope Commercial	$3.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.60
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health Cigna Priority Health	$2.76
Rate for Payer: Priority Health SBD	$2.67

VENLAFAXINE 37.5 MG TABLET

Facility

$423.70

Service Code	NDC 68084084401
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$266.93
Max. Negotiated Rate	$381.33
Rate for Payer: Aetna Commercial	$360.14
Rate for Payer: Aetna New Business (MI Preferred)	$275.40
Rate for Payer: Cash Price	$338.96
Rate for Payer: Cofinity Commercial	$296.59
Rate for Payer: Cofinity Commercial	$364.38
Rate for Payer: Cofinity Medicare Advantage	$296.59
Rate for Payer: Encore Health Key Benefits Commercial	$338.96
Rate for Payer: Healthscope Commercial	$381.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$360.14
Rate for Payer: PHP Commercial	$360.14
Rate for Payer: Priority Health Cigna Priority Health	$275.40
Rate for Payer: Priority Health SBD	$266.93

VENLAFAXINE 37.5 MG TABLET

Facility

$423.70

Service Code	NDC 68084084401
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$169.48
Max. Negotiated Rate	$381.33
Rate for Payer: Aetna Commercial	$360.14
Rate for Payer: Aetna Medicare	$211.85
Rate for Payer: Aetna New Business (MI Preferred)	$275.40
Rate for Payer: BCBS Complete	$169.48
Rate for Payer: Cash Price	$338.96
Rate for Payer: Cofinity Commercial	$296.59
Rate for Payer: Cofinity Commercial	$364.38
Rate for Payer: Cofinity Medicare Advantage	$296.59
Rate for Payer: Encore Health Key Benefits Commercial	$338.96
Rate for Payer: Healthscope Commercial	$381.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$360.14
Rate for Payer: PHP Commercial	$360.14
Rate for Payer: Priority Health Cigna Priority Health	$275.40
Rate for Payer: Priority Health SBD	$266.93

VENLAFAXINE 37.5 MG TABLET

Facility

$289.05

Service Code	NDC 57237017301
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$115.62
Max. Negotiated Rate	$260.14
Rate for Payer: Aetna Commercial	$245.69
Rate for Payer: Aetna Medicare	$144.53
Rate for Payer: Aetna New Business (MI Preferred)	$187.88
Rate for Payer: BCBS Complete	$115.62
Rate for Payer: Cash Price	$231.24
Rate for Payer: Cofinity Commercial	$202.34
Rate for Payer: Cofinity Commercial	$248.58
Rate for Payer: Cofinity Medicare Advantage	$202.34
Rate for Payer: Encore Health Key Benefits Commercial	$231.24
Rate for Payer: Healthscope Commercial	$260.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.69
Rate for Payer: PHP Commercial	$245.69
Rate for Payer: Priority Health Cigna Priority Health	$187.88
Rate for Payer: Priority Health SBD	$182.10

VENLAFAXINE 37.5 MG TABLET

Facility

$289.05

Service Code	NDC 57237017301
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$182.10
Max. Negotiated Rate	$260.14
Rate for Payer: Aetna Commercial	$245.69
Rate for Payer: Aetna New Business (MI Preferred)	$187.88
Rate for Payer: Cash Price	$231.24
Rate for Payer: Cofinity Commercial	$202.34
Rate for Payer: Cofinity Commercial	$248.58
Rate for Payer: Cofinity Medicare Advantage	$202.34
Rate for Payer: Encore Health Key Benefits Commercial	$231.24
Rate for Payer: Healthscope Commercial	$260.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.69
Rate for Payer: PHP Commercial	$245.69
Rate for Payer: Priority Health Cigna Priority Health	$187.88
Rate for Payer: Priority Health SBD	$182.10

VENLAFAXINE 37.5 MG TABLET

Facility

$4.24

Service Code	NDC 68084084411
Hospital Charge Code	12207
Hospital Revenue Code	637
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.76
Rate for Payer: Cash Price	$3.39
Rate for Payer: Cofinity Commercial	$2.97
Rate for Payer: Cofinity Commercial	$3.65
Rate for Payer: Cofinity Medicare Advantage	$2.97
Rate for Payer: Encore Health Key Benefits Commercial	$3.39
Rate for Payer: Healthscope Commercial	$3.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.60
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health Cigna Priority Health	$2.76
Rate for Payer: Priority Health SBD	$2.67

VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$358.15

Service Code	NDC 00904707661
Hospital Charge Code	27859
Hospital Revenue Code	637
Min. Negotiated Rate	$143.26
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 Commercial	$250.71
Rate for Payer: Cofinity Commercial	$308.01
Rate for Payer: Cofinity Medicare Advantage	$250.71
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: PHP Commercial	$304.43
Rate for Payer: Priority Health Cigna Priority Health	$232.80
Rate for Payer: Priority Health SBD	$225.63

VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$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 Commercial	$250.71
Rate for Payer: Cofinity Commercial	$308.01
Rate for Payer: Cofinity Medicare Advantage	$250.71
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: PHP Commercial	$304.43
Rate for Payer: Priority Health Cigna Priority Health	$232.80
Rate for Payer: Priority Health SBD	$225.63

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$268.61

Service Code	NDC 65862052790
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$107.44
Max. Negotiated Rate	$241.75
Rate for Payer: Aetna Commercial	$228.32
Rate for Payer: Aetna Medicare	$134.31
Rate for Payer: Aetna New Business (MI Preferred)	$174.60
Rate for Payer: BCBS Complete	$107.44
Rate for Payer: Cash Price	$214.89
Rate for Payer: Cofinity Commercial	$188.03
Rate for Payer: Cofinity Commercial	$231.00
Rate for Payer: Cofinity Medicare Advantage	$188.03
Rate for Payer: Encore Health Key Benefits Commercial	$214.89
Rate for Payer: Healthscope Commercial	$241.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.32
Rate for Payer: PHP Commercial	$228.32
Rate for Payer: Priority Health Cigna Priority Health	$174.60
Rate for Payer: Priority Health SBD	$169.22

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$437.00

Service Code	NDC 68084069801
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$393.30
Rate for Payer: Aetna Commercial	$371.45
Rate for Payer: Aetna Medicare	$218.50
Rate for Payer: Aetna New Business (MI Preferred)	$284.05
Rate for Payer: BCBS Complete	$174.80
Rate for Payer: Cash Price	$349.60
Rate for Payer: Cofinity Commercial	$305.90
Rate for Payer: Cofinity Commercial	$375.82
Rate for Payer: Cofinity Medicare Advantage	$305.90
Rate for Payer: Encore Health Key Benefits Commercial	$349.60
Rate for Payer: Healthscope Commercial	$393.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.45
Rate for Payer: PHP Commercial	$371.45
Rate for Payer: Priority Health Cigna Priority Health	$284.05
Rate for Payer: Priority Health SBD	$275.31

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$69.80

Service Code	NDC 65862052730
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$62.82
Rate for Payer: Aetna Commercial	$59.33
Rate for Payer: Aetna New Business (MI Preferred)	$45.37
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$48.86
Rate for Payer: Cofinity Commercial	$60.03
Rate for Payer: Cofinity Medicare Advantage	$48.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: PHP Commercial	$59.33
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: Priority Health SBD	$43.97

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$69.80

Service Code	NDC 65862052730
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$62.82
Rate for Payer: Aetna Commercial	$59.33
Rate for Payer: Aetna Medicare	$34.90
Rate for Payer: Aetna New Business (MI Preferred)	$45.37
Rate for Payer: BCBS Complete	$27.92
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$48.86
Rate for Payer: Cofinity Commercial	$60.03
Rate for Payer: Cofinity Medicare Advantage	$48.86
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: PHP Commercial	$59.33
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: Priority Health SBD	$43.97

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.37

Service Code	NDC 68084069811
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare	$2.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.84
Rate for Payer: BCBS Complete	$1.75
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.06
Rate for Payer: Cofinity Commercial	$3.76
Rate for Payer: Cofinity Medicare Advantage	$3.06
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.84
Rate for Payer: Priority Health SBD	$2.75

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.37

Service Code	NDC 68084069811
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna New Business (MI Preferred)	$2.84
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.06
Rate for Payer: Cofinity Commercial	$3.76
Rate for Payer: Cofinity Medicare Advantage	$3.06
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.84
Rate for Payer: Priority Health SBD	$2.75

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$294.50

Service Code	NDC 00904646861
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$117.80
Max. Negotiated Rate	$265.05
Rate for Payer: Aetna Commercial	$250.32
Rate for Payer: Aetna Medicare	$147.25
Rate for Payer: Aetna New Business (MI Preferred)	$191.43
Rate for Payer: BCBS Complete	$117.80
Rate for Payer: Cash Price	$235.60
Rate for Payer: Cofinity Commercial	$206.15
Rate for Payer: Cofinity Commercial	$253.27
Rate for Payer: Cofinity Medicare Advantage	$206.15
Rate for Payer: Encore Health Key Benefits Commercial	$235.60
Rate for Payer: Healthscope Commercial	$265.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$250.32
Rate for Payer: PHP Commercial	$250.32
Rate for Payer: Priority Health Cigna Priority Health	$191.43
Rate for Payer: Priority Health SBD	$185.53

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$268.61

Service Code	NDC 65862052790
Hospital Charge Code	27857
Hospital Revenue Code	637
Min. Negotiated Rate	$169.22
Max. Negotiated Rate	$241.75
Rate for Payer: Aetna Commercial	$228.32
Rate for Payer: Aetna New Business (MI Preferred)	$174.60
Rate for Payer: Cash Price	$214.89
Rate for Payer: Cofinity Commercial	$188.03
Rate for Payer: Cofinity Commercial	$231.00
Rate for Payer: Cofinity Medicare Advantage	$188.03
Rate for Payer: Encore Health Key Benefits Commercial	$214.89
Rate for Payer: Healthscope Commercial	$241.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.32
Rate for Payer: PHP Commercial	$228.32
Rate for Payer: Priority Health Cigna Priority Health	$174.60
Rate for Payer: Priority Health SBD	$169.22

Know your out-of-pocket cost for care.

All Charges