|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: BCBS Trust/PPO |
$31.99
|
| Rate for Payer: BCN Commercial |
$31.99
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC Core |
$34.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$40.10
|
|
|
Service Code
|
HCPCS J3371
|
| Hospital Charge Code |
97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Aetna Commercial |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$30.99
|
| Rate for Payer: BCN Commercial |
$30.99
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Cofinity Commercial |
$34.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.08
|
| Rate for Payer: Healthscope Commercial |
$36.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.08
|
| Rate for Payer: PHP Commercial |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.29
|
| Rate for Payer: UHC Core |
$33.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
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: BCN Commercial |
$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
|
$1,254.39
|
|
|
Service Code
|
NDC 49884-156-76
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$765.05 |
| Max. Negotiated Rate |
$1,128.95 |
| Rate for Payer: Aetna Commercial |
$1,066.23
|
| Rate for Payer: BCBS Trust/PPO |
$969.39
|
| Rate for Payer: BCN Commercial |
$969.39
|
| Rate for Payer: Cash Price |
$1,003.51
|
| Rate for Payer: Cofinity Commercial |
$1,078.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.51
|
| Rate for Payer: Healthscope Commercial |
$1,128.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,066.23
|
| Rate for Payer: PHP Commercial |
$1,066.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$878.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,091.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$765.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.86
|
| Rate for Payer: UHC Core |
$1,047.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.79
|
|
|
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 |
$163.11 |
| Max. Negotiated Rate |
$240.69 |
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: BCBS Trust/PPO |
$206.67
|
| Rate for Payer: BCN Commercial |
$206.67
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.57
|
| 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 HMO/PPO/Tiered Network |
$232.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.34
|
| Rate for Payer: UHC Core |
$223.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.57
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$116.97
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$105.27 |
| Rate for Payer: Aetna Commercial |
$99.42
|
| Rate for Payer: Aetna Commercial |
$227.32
|
| Rate for Payer: BCBS Trust/PPO |
$206.67
|
| Rate for Payer: BCBS Trust/PPO |
$90.39
|
| Rate for Payer: BCN Commercial |
$206.67
|
| Rate for Payer: BCN Commercial |
$90.39
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Commercial |
$229.99
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$105.27
|
| Rate for Payer: Healthscope Commercial |
$240.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.73
|
| 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: PHP Commercial |
$99.42
|
| Rate for Payer: PHP Commercial |
$227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.93
|
| Rate for Payer: UHC Core |
$97.67
|
| Rate for Payer: UHC Core |
$223.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.57
|
|
|
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 |
$2.53 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.21
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| 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 HMO/PPO/Tiered Network |
$3.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
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 |
$252.62 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: BCBS Trust/PPO |
$320.09
|
| Rate for Payer: BCN Commercial |
$320.09
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| 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 HMO/PPO/Tiered Network |
$360.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.50
|
| Rate for Payer: UHC Core |
$345.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079-480-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.05
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| 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: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$68.97
|
|
|
Service Code
|
NDC 0093-7384-56
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Aetna Commercial |
$58.62
|
| Rate for Payer: BCBS Trust/PPO |
$53.30
|
| Rate for Payer: BCN Commercial |
$53.30
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$59.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.62
|
| Rate for Payer: PHP Commercial |
$58.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.69
|
| Rate for Payer: UHC Core |
$57.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
|
|
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 |
$36.98 |
| Max. Negotiated Rate |
$54.57 |
| Rate for Payer: Aetna Commercial |
$51.54
|
| Rate for Payer: BCBS Trust/PPO |
$46.85
|
| Rate for Payer: BCN Commercial |
$46.85
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$52.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$54.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.47
|
| 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 HMO/PPO/Tiered Network |
$52.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.35
|
| Rate for Payer: UHC Core |
$50.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.47
|
|
|
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 |
$179.62 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: BCBS Trust/PPO |
$227.59
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| 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 HMO/PPO/Tiered Network |
$256.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.16
|
| Rate for Payer: UHC Core |
$245.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$283.10
|
|
|
Service Code
|
NDC 0904-7075-61
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.66 |
| Max. Negotiated Rate |
$254.79 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: BCBS Trust/PPO |
$218.78
|
| Rate for Payer: BCN Commercial |
$218.78
|
| Rate for Payer: Cash Price |
$226.48
|
| 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: Lakeland Regional Health Systems Commercial |
$212.32
|
| 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 HMO/PPO/Tiered Network |
$246.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.13
|
| Rate for Payer: UHC Core |
$236.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.32
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$209.39
|
|
|
Service Code
|
NDC 65862-528-90
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.71 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Aetna Commercial |
$177.98
|
| Rate for Payer: BCBS Trust/PPO |
$161.82
|
| Rate for Payer: BCN Commercial |
$161.82
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cofinity Commercial |
$180.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.51
|
| Rate for Payer: Healthscope Commercial |
$188.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.98
|
| Rate for Payer: PHP Commercial |
$177.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.26
|
| Rate for Payer: UHC Core |
$174.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.04
|
|
|
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 |
$283.33 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: BCBS Trust/PPO |
$359.00
|
| Rate for Payer: BCN Commercial |
$359.00
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$399.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$418.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.41
|
| 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 HMO/PPO/Tiered Network |
$404.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.80
|
| Rate for Payer: UHC Core |
$387.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.41
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$290.70
|
|
|
Service Code
|
NDC 0904-7077-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.30 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: BCBS Trust/PPO |
$224.65
|
| Rate for Payer: BCN Commercial |
$224.65
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.82
|
| Rate for Payer: UHC Core |
$242.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.95
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.09
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$296.40
|
|
|
Service Code
|
NDC 0904-6469-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.77 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: BCBS Trust/PPO |
$229.06
|
| Rate for Payer: BCN Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.83
|
| Rate for Payer: UHC Core |
$247.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$70.50
|
|
|
Service Code
|
NDC 65862-528-30
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$54.48
|
| Rate for Payer: BCN Commercial |
$54.48
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$102.90
|
|
|
Service Code
|
NDC 66993-019-68
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.76 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.46
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$79.52
|
| Rate for Payer: Cash Price |
$82.32
|
| 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: Lakeland Regional Health Systems Commercial |
$77.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.46
|
| Rate for Payer: PHP Commercial |
$87.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.55
|
| Rate for Payer: UHC Core |
$85.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.18
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$116.90
|
|
|
Service Code
|
NDC 0254-1007-52
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$90.34
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.36
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.87
|
| Rate for Payer: UHC Core |
$97.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.68
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$66.78
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.73 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: BCBS Trust/PPO |
$51.61
|
| Rate for Payer: BCN Commercial |
$51.61
|
| Rate for Payer: Cash Price |
$53.42
|
| 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: Lakeland Regional Health Systems Commercial |
$50.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.76
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.77
|
| Rate for Payer: UHC Core |
$55.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.08
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$36.70
|
|
|
Service Code
|
NDC 0409-4011-01
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.38 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.36
|
| Rate for Payer: BCN Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$29.36
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.36
|
| Rate for Payer: Healthscope Commercial |
$33.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.20
|
| Rate for Payer: PHP Commercial |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.30
|
| Rate for Payer: UHC Core |
$30.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.52
|
|
|
VERAPAMIL 80 MG TABLET
|
Facility
IP
|
$101.05
|
|
|
Service Code
|
NDC 23155-026-01
|
| Hospital Charge Code |
8530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.63 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.09
|
| Rate for Payer: BCN Commercial |
$78.09
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.89
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
VERAPAMIL 80 MG TABLET
|
Facility
IP
|
$162.15
|
|
|
Service Code
|
NDC 0904-2920-61
|
| Hospital Charge Code |
8530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.90 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: BCBS Trust/PPO |
$125.31
|
| Rate for Payer: BCN Commercial |
$125.31
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
