|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628-201-10
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$603.29 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.32
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628-016-10
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.95
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
IP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: Priority Health SBD |
$6.54
|
|
|
VANTAS IMPLANT
|
Professional
|
$3,334.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,333.60 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: BCBS Complete |
$1,333.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Cash Price |
$2,667.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,333.80
|
|
|
VARENICLINE 1 MG TABLET
|
Facility
IP
|
$43.29
|
|
|
Service Code
|
NDC 60687-648-11
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.27 |
| Max. Negotiated Rate |
$38.96 |
| Rate for Payer: Aetna Commercial |
$36.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.14
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cofinity Commercial |
$30.30
|
| Rate for Payer: Cofinity Commercial |
$37.23
|
| Rate for Payer: Healthscope Commercial |
$38.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.80
|
| Rate for Payer: PHP Commercial |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.30
|
| Rate for Payer: Priority Health SBD |
$27.27
|
|
|
VARENICLINE 1 MG TABLET
|
Facility
IP
|
$1,298.59
|
|
|
Service Code
|
NDC 60687-648-21
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$818.11 |
| Max. Negotiated Rate |
$1,168.73 |
| Rate for Payer: Aetna Commercial |
$1,103.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.08
|
| Rate for Payer: Cash Price |
$1,038.87
|
| Rate for Payer: Cofinity Commercial |
$1,116.79
|
| Rate for Payer: Cofinity Commercial |
$909.01
|
| Rate for Payer: Healthscope Commercial |
$1,168.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,103.80
|
| Rate for Payer: PHP Commercial |
$1,103.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.01
|
| Rate for Payer: Priority Health SBD |
$818.11
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$763.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.61
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$226.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
IP
|
$267.43
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$240.69 |
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.83
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cofinity Commercial |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.32
|
| Rate for Payer: PHP Commercial |
$227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health SBD |
$168.48
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$267.43
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$240.69 |
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Cofinity Commercial |
$81.88
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$105.27
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.67
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$73.69
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$168.48
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$22,533.11
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,195.86 |
| Max. Negotiated Rate |
$20,279.80 |
| Rate for Payer: Aetna Commercial |
$19,153.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,646.52
|
| Rate for Payer: Cash Price |
$18,026.49
|
| Rate for Payer: Cofinity Commercial |
$15,773.18
|
| Rate for Payer: Cofinity Commercial |
$19,378.47
|
| Rate for Payer: Healthscope Commercial |
$20,279.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,153.14
|
| Rate for Payer: PHP Commercial |
$19,153.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,773.18
|
| Rate for Payer: Priority Health SBD |
$14,195.86
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
IP
|
$44,363.77
|
|
|
Service Code
|
MS-DRG 263
|
| Min. Negotiated Rate |
$19,797.28 |
| Max. Negotiated Rate |
$44,363.77 |
| Rate for Payer: Aetna Medicare |
$21,672.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,049.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,049.05
|
| Rate for Payer: BCBS MAPPO |
$20,839.24
|
| Rate for Payer: BCBS Trust/PPO |
$44,363.77
|
| Rate for Payer: BCN Medicare Advantage |
$20,839.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,839.24
|
| Rate for Payer: Mclaren Medicare |
$20,839.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,881.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,965.13
|
| Rate for Payer: PACE Medicare |
$19,797.28
|
| Rate for Payer: PACE SWMI |
$20,839.24
|
| Rate for Payer: PHP Medicare Advantage |
$20,839.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,541.39
|
| Rate for Payer: Priority Health Medicare |
$20,839.24
|
| Rate for Payer: Priority Health Narrow Network |
$32,433.11
|
| Rate for Payer: Railroad Medicare Medicare |
$20,839.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,095.60
|
| Rate for Payer: UHC Core |
$26,443.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,839.24
|
| Rate for Payer: UHC Exchange |
$28,322.63
|
| Rate for Payer: UHC Medicare Advantage |
$21,464.42
|
| Rate for Payer: VA VA |
$20,839.24
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
IP
|
$3.84
|
|
|
Service Code
|
NDC 68084-896-95
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.42
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
IP
|
$115.20
|
|
|
Service Code
|
NDC 68084-896-25
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.88
|
| Rate for Payer: Cash Price |
$92.16
|
| Rate for Payer: Cofinity Commercial |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Healthscope Commercial |
$103.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.92
|
| Rate for Payer: PHP Commercial |
$97.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.64
|
| Rate for Payer: Priority Health SBD |
$72.58
|
|
|
VENLAFAXINE 25 MG TABLET
|
Facility
IP
|
$283.10
|
|
|
Service Code
|
NDC 57664-392-88
|
| Hospital Charge Code |
12203
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.35 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.02
|
| Rate for Payer: Cash Price |
$226.48
|
| Rate for Payer: Cofinity Commercial |
$198.17
|
| Rate for Payer: Cofinity Commercial |
$243.47
|
| Rate for Payer: Healthscope Commercial |
$254.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.64
|
| Rate for Payer: PHP Commercial |
$240.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.17
|
| Rate for Payer: Priority Health SBD |
$178.35
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$4.15
|
|
|
Service Code
|
NDC 68084-844-11
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.53
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.61
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$264.96
|
|
|
Service Code
|
NDC 51079-480-20
|
| 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: Healthscope Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.22
|
| Rate for Payer: PHP Commercial |
$225.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.47
|
| Rate for Payer: Priority Health SBD |
$166.92
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$414.20
|
|
|
Service Code
|
NDC 68084-844-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.07
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.94
|
| Rate for Payer: Priority Health SBD |
$260.95
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$246.75
|
|
|
Service Code
|
NDC 57237-173-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.45 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$357.20
|
|
|
Service Code
|
NDC 0904-7076-61
|
| Hospital Charge Code |
27859
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.04 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| Rate for Payer: Priority Health SBD |
$225.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$60.63
|
|
|
Service Code
|
NDC 65862-527-30
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$54.57 |
| Rate for Payer: Aetna Commercial |
$51.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.41
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.54
|
| Rate for Payer: PHP Commercial |
$51.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.44
|
| Rate for Payer: Priority Health SBD |
$38.20
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$294.50
|
|
|
Service Code
|
NDC 0904-6468-61
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.54 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.42
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$206.15
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.32
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.15
|
| Rate for Payer: Priority Health SBD |
$185.54
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
NDC 68084-698-11
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.65
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$419.90
|
|
|
Service Code
|
NDC 68084-698-01
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$293.93
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.92
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health SBD |
$264.54
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$230.54
|
|
|
Service Code
|
NDC 65862-527-90
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$207.49 |
| Rate for Payer: Aetna Commercial |
$195.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.85
|
| Rate for Payer: Cash Price |
$184.43
|
| Rate for Payer: Cofinity Commercial |
$198.26
|
| Rate for Payer: Cofinity Commercial |
$161.38
|
| Rate for Payer: Healthscope Commercial |
$207.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.96
|
| Rate for Payer: PHP Commercial |
$195.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.38
|
| Rate for Payer: Priority Health SBD |
$145.24
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084-709-01
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.67 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.96
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$399.51
|
| Rate for Payer: Healthscope Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.87
|
| Rate for Payer: PHP Commercial |
$394.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.18
|
| Rate for Payer: Priority Health SBD |
$292.67
|
|
