|
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 |
$46.63 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna Commercial |
$224.81
|
| Rate for Payer: Aetna Medicare |
$68.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.65
|
| Rate for Payer: BCBS Complete |
$48.96
|
| Rate for Payer: BCBS MAPPO |
$66.12
|
| Rate for Payer: BCBS Trust/PPO |
$217.43
|
| Rate for Payer: BCN Commercial |
$217.43
|
| Rate for Payer: BCN Medicare Advantage |
$66.12
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cofinity Commercial |
$227.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.12
|
| Rate for Payer: Healthscope Commercial |
$238.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.36
|
| Rate for Payer: Mclaren Medicaid |
$46.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.43
|
| Rate for Payer: Meridian Medicaid |
$48.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.81
|
| Rate for Payer: Nomi Health Commercial |
$216.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.36
|
| Rate for Payer: PACE Senior Care Partners |
$62.81
|
| Rate for Payer: PACE SWMI |
$66.12
|
| Rate for Payer: PHP Commercial |
$224.81
|
| Rate for Payer: PHP Medicare Advantage |
$66.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.10
|
| Rate for Payer: Priority Health Medicare |
$66.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.08
|
| Rate for Payer: Railroad Medicare Medicare |
$66.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.74
|
| Rate for Payer: UHC Core |
$220.84
|
| Rate for Payer: UHC Exchange |
$66.12
|
| Rate for Payer: UHC Medicaid |
$46.63
|
| Rate for Payer: UHC Medicare Advantage |
$66.12
|
| Rate for Payer: UHCCP Medicaid |
$46.63
|
| Rate for Payer: VA VA |
$66.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.36
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$67.55
|
|
|
Service Code
|
NDC 00093738456
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.79
|
| Rate for Payer: BCN Commercial |
$55.79
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Nomi Health Commercial |
$55.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.44
|
| Rate for Payer: UHC Core |
$56.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.66
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$81.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.67
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCBS Trust/PPO |
$256.95
|
| Rate for Payer: BCN Commercial |
$256.95
|
| Rate for Payer: BCN Medicare Advantage |
$78.14
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Mclaren Medicaid |
$55.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.04
|
| Rate for Payer: Meridian Medicaid |
$57.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PACE Senior Care Partners |
$74.23
|
| Rate for Payer: PACE SWMI |
$78.14
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: PHP Medicare Advantage |
$78.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.92
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.53
|
| Rate for Payer: Railroad Medicare Medicare |
$78.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.04
|
| Rate for Payer: UHC Core |
$260.98
|
| Rate for Payer: UHC Exchange |
$78.14
|
| Rate for Payer: UHC Medicaid |
$55.10
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| Rate for Payer: UHCCP Medicaid |
$55.10
|
| Rate for Payer: VA VA |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
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 |
$1.84 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| 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 Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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
|
OP
|
$67.55
|
|
|
Service Code
|
NDC 00093738456
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.11
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: BCBS MAPPO |
$16.89
|
| Rate for Payer: BCBS Trust/PPO |
$55.53
|
| Rate for Payer: BCN Commercial |
$55.53
|
| Rate for Payer: BCN Medicare Advantage |
$16.89
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.89
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.66
|
| Rate for Payer: Mclaren Medicaid |
$11.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.73
|
| Rate for Payer: Meridian Medicaid |
$12.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Nomi Health Commercial |
$55.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PACE Senior Care Partners |
$16.04
|
| Rate for Payer: PACE SWMI |
$16.89
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: PHP Medicare Advantage |
$16.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.77
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.01
|
| Rate for Payer: Railroad Medicare Medicare |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.44
|
| Rate for Payer: UHC Core |
$56.40
|
| Rate for Payer: UHC Exchange |
$16.89
|
| Rate for Payer: UHC Medicaid |
$11.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.89
|
| Rate for Payer: UHCCP Medicaid |
$11.91
|
| Rate for Payer: VA VA |
$16.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.66
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: BCBS Trust/PPO |
$258.14
|
| Rate for Payer: BCN Commercial |
$258.14
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.04
|
| Rate for Payer: UHC Core |
$260.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
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 |
$0.47 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.83
|
| Rate for Payer: BCBS Complete |
$0.49
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| 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: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: Meridian Medicaid |
$0.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PACE Senior Care Partners |
$0.63
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.31
|
| Rate for Payer: Priority Health Medicare |
$0.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UHC Medicaid |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| Rate for Payer: VA VA |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
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 |
$12.55 |
| Max. Negotiated Rate |
$64.09 |
| Rate for Payer: Aetna Commercial |
$60.53
|
| Rate for Payer: Aetna Medicare |
$18.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.25
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$17.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.54
|
| Rate for Payer: BCN Commercial |
$58.54
|
| Rate for Payer: BCN Medicare Advantage |
$17.80
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cofinity Commercial |
$61.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.41
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.69
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.53
|
| Rate for Payer: Nomi Health Commercial |
$58.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.41
|
| Rate for Payer: PACE Senior Care Partners |
$16.91
|
| Rate for Payer: PACE SWMI |
$17.80
|
| Rate for Payer: PHP Commercial |
$60.53
|
| Rate for Payer: PHP Medicare Advantage |
$17.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.95
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.46
|
| Rate for Payer: UHC Exchange |
$17.80
|
| Rate for Payer: UHC Medicaid |
$12.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.80
|
| Rate for Payer: UHCCP Medicaid |
$12.55
|
| Rate for Payer: VA VA |
$17.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.41
|
|
|
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 |
$49.56 |
| Max. Negotiated Rate |
$64.09 |
| Rate for Payer: Aetna Commercial |
$60.53
|
| Rate for Payer: BCBS Trust/PPO |
$58.81
|
| Rate for Payer: BCN Commercial |
$58.81
|
| Rate for Payer: Cash Price |
$56.97
|
| 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: Lakeland Regional Health Systems Commercial |
$53.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.53
|
| Rate for Payer: Nomi Health Commercial |
$58.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.41
|
| Rate for Payer: PHP Commercial |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$59.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.41
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$72.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.60
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS MAPPO |
$70.08
|
| Rate for Payer: BCBS Trust/PPO |
$230.45
|
| Rate for Payer: BCN Commercial |
$230.45
|
| Rate for Payer: BCN Medicare Advantage |
$70.08
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.08
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Mclaren Medicaid |
$49.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.58
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PACE Senior Care Partners |
$66.58
|
| Rate for Payer: PACE SWMI |
$70.08
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Medicare |
$70.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.10
|
| Rate for Payer: Railroad Medicare Medicare |
$70.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicaid |
$49.42
|
| Rate for Payer: UHC Medicare Advantage |
$70.08
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
| Rate for Payer: VA VA |
$70.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 |
$154.57 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: BCBS Trust/PPO |
$183.42
|
| Rate for Payer: BCN Commercial |
$183.42
|
| Rate for Payer: Cash Price |
$177.66
|
| 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: Lakeland Regional Health Systems Commercial |
$166.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Nomi Health Commercial |
$182.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.43
|
| Rate for Payer: UHC Core |
$185.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.56
|
|
|
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 |
$39.15 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.40
|
| Rate for Payer: BCBS Complete |
$41.11
|
| Rate for Payer: BCBS MAPPO |
$55.52
|
| Rate for Payer: BCBS Trust/PPO |
$182.57
|
| Rate for Payer: BCN Commercial |
$182.57
|
| Rate for Payer: BCN Medicare Advantage |
$55.52
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.52
|
| Rate for Payer: Healthscope Commercial |
$199.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.56
|
| Rate for Payer: Mclaren Medicaid |
$39.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.30
|
| Rate for Payer: Meridian Medicaid |
$41.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Nomi Health Commercial |
$182.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PACE Senior Care Partners |
$52.74
|
| Rate for Payer: PACE SWMI |
$55.52
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: PHP Medicare Advantage |
$55.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.21
|
| Rate for Payer: Priority Health Medicare |
$56.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.57
|
| Rate for Payer: Railroad Medicare Medicare |
$55.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.43
|
| Rate for Payer: UHC Core |
$185.44
|
| Rate for Payer: UHC Exchange |
$55.52
|
| Rate for Payer: UHC Medicaid |
$39.15
|
| Rate for Payer: UHC Medicare Advantage |
$55.52
|
| Rate for Payer: UHCCP Medicaid |
$39.15
|
| Rate for Payer: VA VA |
$55.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.56
|
|
|
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 |
$13.30 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.57
|
| Rate for Payer: BCBS Complete |
$13.96
|
| Rate for Payer: BCBS MAPPO |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$62.02
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.86
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.58
|
| Rate for Payer: Mclaren Medicaid |
$13.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.80
|
| Rate for Payer: Meridian Medicaid |
$13.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Nomi Health Commercial |
$61.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PACE Senior Care Partners |
$17.92
|
| Rate for Payer: PACE SWMI |
$18.86
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: PHP Medicare Advantage |
$18.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.63
|
| Rate for Payer: Priority Health Medicare |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.51
|
| Rate for Payer: Railroad Medicare Medicare |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.39
|
| Rate for Payer: UHC Core |
$62.99
|
| Rate for Payer: UHC Exchange |
$18.86
|
| Rate for Payer: UHC Medicaid |
$13.30
|
| Rate for Payer: UHC Medicare Advantage |
$18.86
|
| Rate for Payer: UHCCP Medicaid |
$13.30
|
| Rate for Payer: VA VA |
$18.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.58
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$254.88
|
|
|
Service Code
|
NDC 00904748861
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.65
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$209.54
|
| Rate for Payer: BCN Commercial |
$209.54
|
| Rate for Payer: BCN Medicare Advantage |
$63.72
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.72
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PACE Senior Care Partners |
$60.53
|
| Rate for Payer: PACE SWMI |
$63.72
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: PHP Medicare Advantage |
$63.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.40
|
| Rate for Payer: Railroad Medicare Medicare |
$63.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHC Medicare Advantage |
$63.72
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: VA VA |
$63.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
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 |
$195.10 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: BCBS Trust/PPO |
$231.52
|
| Rate for Payer: BCN Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$224.26
|
| 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: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 |
$0.50 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.88
|
| Rate for Payer: BCBS Complete |
$0.52
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.11
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.74
|
| Rate for Payer: Meridian Medicaid |
$0.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.44
|
| Rate for Payer: Priority Health Medicare |
$0.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.47
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: UHC Exchange |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.11
|
|
|
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 |
$52.51 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.31
|
| Rate for Payer: BCN Commercial |
$62.31
|
| Rate for Payer: Cash Price |
$60.35
|
| 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: Lakeland Regional Health Systems Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Nomi Health Commercial |
$61.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.39
|
| Rate for Payer: UHC Core |
$62.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.58
|
|
|
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 |
$1.96 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.25
|
| 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: Lakeland Regional Health Systems Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.39
|
| Rate for Payer: Nomi Health Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.47
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.11
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.26 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.50
|
| Rate for Payer: BCN Commercial |
$249.50
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 00904748861
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: BCBS Trust/PPO |
$210.51
|
| Rate for Payer: BCN Commercial |
$210.51
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Nomi Health Commercial |
$209.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.29
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.16
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.41
|
| Rate for Payer: BCBS Complete |
$55.92
|
| Rate for Payer: BCBS MAPPO |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$75.53
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.53
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Mclaren Medicaid |
$53.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.30
|
| Rate for Payer: Meridian Medicaid |
$55.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: PACE Senior Care Partners |
$71.75
|
| Rate for Payer: PACE SWMI |
$75.53
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: PHP Medicare Advantage |
$75.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.26
|
| Rate for Payer: Railroad Medicare Medicare |
$75.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicaid |
$53.26
|
| Rate for Payer: UHC Medicare Advantage |
$75.53
|
| Rate for Payer: UHCCP Medicaid |
$53.26
|
| Rate for Payer: VA VA |
$75.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
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 |
$46.48 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: BCBS Trust/PPO |
$55.15
|
| Rate for Payer: BCN Commercial |
$55.15
|
| 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 |
$50.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.09
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.48
|
| 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 |
$50.09
|
|
|
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 |
$71.62 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: BCBS Trust/PPO |
$84.99
|
| Rate for Payer: BCN Commercial |
$84.99
|
| 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 |
$77.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.47
|
| Rate for Payer: Nomi Health Commercial |
$84.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.17
|
| Rate for Payer: PHP Commercial |
$87.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.62
|
| 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 |
$77.17
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$102.90
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: Aetna Medicare |
$26.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.16
|
| Rate for Payer: BCBS Complete |
$19.05
|
| Rate for Payer: BCBS MAPPO |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$84.59
|
| Rate for Payer: BCN Commercial |
$84.59
|
| Rate for Payer: BCN Medicare Advantage |
$25.73
|
| 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: Health Alliance Plan Medicare Advantage |
$25.73
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.17
|
| Rate for Payer: Mclaren Medicaid |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.01
|
| Rate for Payer: Meridian Medicaid |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.47
|
| Rate for Payer: Nomi Health Commercial |
$84.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.17
|
| Rate for Payer: PACE Senior Care Partners |
$24.44
|
| Rate for Payer: PACE SWMI |
$25.73
|
| Rate for Payer: PHP Commercial |
$87.47
|
| Rate for Payer: PHP Medicare Advantage |
$25.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.52
|
| Rate for Payer: Priority Health Medicare |
$25.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.62
|
| Rate for Payer: Railroad Medicare Medicare |
$25.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.55
|
| Rate for Payer: UHC Core |
$85.92
|
| Rate for Payer: UHC Exchange |
$25.73
|
| Rate for Payer: UHC Medicaid |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$25.73
|
| Rate for Payer: UHCCP Medicaid |
$18.14
|
| Rate for Payer: VA VA |
$25.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.17
|
|
|
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 |
$11.77 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.87
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS MAPPO |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$54.90
|
| Rate for Payer: BCN Commercial |
$54.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.70
|
| 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: Health Alliance Plan Medicare Advantage |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$60.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.09
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.53
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.76
|
| Rate for Payer: Nomi Health Commercial |
$54.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.09
|
| Rate for Payer: PACE Senior Care Partners |
$15.86
|
| Rate for Payer: PACE SWMI |
$16.70
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: PHP Medicare Advantage |
$16.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.10
|
| Rate for Payer: Priority Health Medicare |
$16.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.77
|
| Rate for Payer: UHC Core |
$55.76
|
| Rate for Payer: UHC Exchange |
$16.70
|
| Rate for Payer: UHC Medicaid |
$11.77
|
| Rate for Payer: UHC Medicare Advantage |
$16.70
|
| Rate for Payer: UHCCP Medicaid |
$11.77
|
| Rate for Payer: VA VA |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.09
|
|
