|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$250.53
|
|
|
Service Code
|
NDC 49884015676
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$225.48 |
| Rate for Payer: Aetna Commercial |
$212.95
|
| Rate for Payer: Aetna Medicare |
$65.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.29
|
| Rate for Payer: BCBS Complete |
$100.21
|
| Rate for Payer: BCBS MAPPO |
$62.63
|
| Rate for Payer: BCBS Trust/PPO |
$205.96
|
| Rate for Payer: BCN Commercial |
$194.79
|
| Rate for Payer: BCN Medicare Advantage |
$62.63
|
| Rate for Payer: Cash Price |
$200.42
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.63
|
| Rate for Payer: Healthscope Commercial |
$225.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.95
|
| Rate for Payer: Nomi Health Commercial |
$205.43
|
| Rate for Payer: PACE Senior Care Partners |
$59.50
|
| Rate for Payer: PACE SWMI |
$62.63
|
| Rate for Payer: PHP Commercial |
$212.95
|
| Rate for Payer: PHP Medicare Advantage |
$62.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.84
|
| Rate for Payer: Priority Health HMO/PPO |
$217.96
|
| Rate for Payer: Priority Health Medicare |
$63.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.86
|
| Rate for Payer: Railroad Medicare Medicare |
$62.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.47
|
| Rate for Payer: UHC Core |
$209.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.63
|
| Rate for Payer: UHC Exchange |
$62.63
|
| Rate for Payer: UHC Medicare Advantage |
$62.63
|
| Rate for Payer: VA VA |
$62.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.90
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$960.38
|
|
|
Service Code
|
NDC 70710161406
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.25 |
| Max. Negotiated Rate |
$864.34 |
| Rate for Payer: Aetna Commercial |
$816.32
|
| Rate for Payer: BCBS Trust/PPO |
$783.96
|
| Rate for Payer: BCN Commercial |
$742.18
|
| Rate for Payer: Cash Price |
$768.30
|
| Rate for Payer: Cofinity Commercial |
$825.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.30
|
| Rate for Payer: Healthscope Commercial |
$864.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.32
|
| Rate for Payer: Nomi Health Commercial |
$787.51
|
| Rate for Payer: PHP Commercial |
$816.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.25
|
| Rate for Payer: Priority Health HMO/PPO |
$835.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.13
|
| Rate for Payer: UHC Core |
$801.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.28
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$960.38
|
|
|
Service Code
|
NDC 70710161406
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.09 |
| Max. Negotiated Rate |
$864.34 |
| Rate for Payer: Aetna Commercial |
$816.32
|
| Rate for Payer: Aetna Medicare |
$249.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$300.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$300.12
|
| Rate for Payer: BCBS Complete |
$384.15
|
| Rate for Payer: BCBS MAPPO |
$240.10
|
| Rate for Payer: BCBS Trust/PPO |
$789.53
|
| Rate for Payer: BCN Commercial |
$746.70
|
| Rate for Payer: BCN Medicare Advantage |
$240.10
|
| Rate for Payer: Cash Price |
$768.30
|
| Rate for Payer: Cofinity Commercial |
$825.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.10
|
| Rate for Payer: Healthscope Commercial |
$864.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.32
|
| Rate for Payer: Nomi Health Commercial |
$787.51
|
| Rate for Payer: PACE Senior Care Partners |
$228.09
|
| Rate for Payer: PACE SWMI |
$240.10
|
| Rate for Payer: PHP Commercial |
$816.32
|
| Rate for Payer: PHP Medicare Advantage |
$240.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.25
|
| Rate for Payer: Priority Health HMO/PPO |
$835.53
|
| Rate for Payer: Priority Health Medicare |
$242.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.45
|
| Rate for Payer: Railroad Medicare Medicare |
$240.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.13
|
| Rate for Payer: UHC Core |
$801.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.10
|
| Rate for Payer: UHC Exchange |
$240.10
|
| Rate for Payer: UHC Medicare Advantage |
$240.10
|
| Rate for Payer: VA VA |
$240.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.28
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
IP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: BCBS Trust/PPO |
$76.15
|
| Rate for Payer: BCN Commercial |
$72.09
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Nomi Health Commercial |
$76.50
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health HMO/PPO |
$81.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$77.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Medicare |
$24.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.15
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCN Commercial |
$72.53
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Nomi Health Commercial |
$76.50
|
| Rate for Payer: PACE Senior Care Partners |
$22.16
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health HMO/PPO |
$81.16
|
| Rate for Payer: Priority Health Medicare |
$23.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.50
|
| Rate for Payer: Railroad Medicare Medicare |
$23.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$77.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.32
|
| Rate for Payer: UHC Exchange |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$23.32
|
| Rate for Payer: VA VA |
$23.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$120.17
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$108.15 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: BCBS Trust/PPO |
$98.09
|
| Rate for Payer: BCBS Trust/PPO |
$76.15
|
| Rate for Payer: BCN Commercial |
$92.87
|
| Rate for Payer: BCN Commercial |
$72.09
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Nomi Health Commercial |
$98.54
|
| Rate for Payer: Nomi Health Commercial |
$76.50
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health HMO/PPO |
$81.16
|
| Rate for Payer: Priority Health HMO/PPO |
$104.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$100.34
|
| Rate for Payer: UHC Core |
$77.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Medicare |
$24.26
|
| Rate for Payer: Aetna Medicare |
$31.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.55
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS MAPPO |
$30.04
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCBS Trust/PPO |
$98.79
|
| Rate for Payer: BCN Commercial |
$72.53
|
| Rate for Payer: BCN Commercial |
$93.43
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$30.04
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Nomi Health Commercial |
$76.50
|
| Rate for Payer: Nomi Health Commercial |
$98.54
|
| Rate for Payer: PACE Senior Care Partners |
$22.16
|
| Rate for Payer: PACE Senior Care Partners |
$28.54
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PACE SWMI |
$30.04
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Medicare Advantage |
$30.04
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health HMO/PPO |
$104.55
|
| Rate for Payer: Priority Health HMO/PPO |
$81.16
|
| Rate for Payer: Priority Health Medicare |
$23.56
|
| Rate for Payer: Priority Health Medicare |
$30.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: Railroad Medicare Medicare |
$30.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$77.90
|
| Rate for Payer: UHC Core |
$100.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.04
|
| Rate for Payer: UHC Exchange |
$30.04
|
| Rate for Payer: UHC Exchange |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$30.04
|
| Rate for Payer: UHC Medicare Advantage |
$23.32
|
| Rate for Payer: VA VA |
$30.04
|
| Rate for Payer: VA VA |
$23.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.13
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna Medicare |
$99.89
|
| Rate for Payer: Aetna Medicare |
$116.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.68
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$111.74
|
| Rate for Payer: BCBS MAPPO |
$96.05
|
| Rate for Payer: BCBS Trust/PPO |
$315.85
|
| Rate for Payer: BCBS Trust/PPO |
$367.45
|
| Rate for Payer: BCN Commercial |
$298.72
|
| Rate for Payer: BCN Commercial |
$347.52
|
| Rate for Payer: BCN Medicare Advantage |
$96.05
|
| Rate for Payer: BCN Medicare Advantage |
$111.74
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.23
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.85
|
| Rate for Payer: Meridian Medicaid |
$2.76
|
| Rate for Payer: Meridian Medicaid |
$2.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Nomi Health Commercial |
$315.04
|
| Rate for Payer: Nomi Health Commercial |
$366.52
|
| Rate for Payer: PACE Senior Care Partners |
$91.25
|
| Rate for Payer: PACE Senior Care Partners |
$106.16
|
| Rate for Payer: PACE SWMI |
$96.05
|
| Rate for Payer: PACE SWMI |
$111.74
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Medicare Advantage |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$111.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health HMO/PPO |
$388.86
|
| Rate for Payer: Priority Health HMO/PPO |
$334.25
|
| Rate for Payer: Priority Health Medicare |
$97.01
|
| Rate for Payer: Priority Health Medicare |
$112.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.47
|
| Rate for Payer: Railroad Medicare Medicare |
$111.74
|
| Rate for Payer: Railroad Medicare Medicare |
$96.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.10
|
| Rate for Payer: UHC Core |
$373.22
|
| Rate for Payer: UHC Core |
$320.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.74
|
| Rate for Payer: UHC Exchange |
$111.74
|
| Rate for Payer: UHC Exchange |
$96.05
|
| Rate for Payer: UHC Medicare Advantage |
$111.74
|
| Rate for Payer: UHC Medicare Advantage |
$96.05
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: VA VA |
$96.05
|
| Rate for Payer: VA VA |
$111.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.23
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.73 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: BCBS Trust/PPO |
$313.62
|
| Rate for Payer: BCBS Trust/PPO |
$364.86
|
| Rate for Payer: BCN Commercial |
$296.91
|
| Rate for Payer: BCN Commercial |
$345.42
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Nomi Health Commercial |
$315.04
|
| Rate for Payer: Nomi Health Commercial |
$366.52
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health HMO/PPO |
$388.86
|
| Rate for Payer: Priority Health HMO/PPO |
$334.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.33
|
| Rate for Payer: UHC Core |
$320.81
|
| Rate for Payer: UHC Core |
$373.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.23
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.63 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna Medicare |
$110.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.41
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: BCBS MAPPO |
$105.92
|
| Rate for Payer: BCBS Trust/PPO |
$348.32
|
| Rate for Payer: BCN Commercial |
$329.43
|
| Rate for Payer: BCN Medicare Advantage |
$105.92
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.92
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: PACE Senior Care Partners |
$100.63
|
| Rate for Payer: PACE SWMI |
$105.92
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: PHP Medicare Advantage |
$105.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$368.62
|
| Rate for Payer: Priority Health Medicare |
$106.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.88
|
| Rate for Payer: Railroad Medicare Medicare |
$105.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.86
|
| Rate for Payer: UHC Core |
$353.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.92
|
| Rate for Payer: UHC Exchange |
$105.92
|
| Rate for Payer: UHC Medicare Advantage |
$105.92
|
| Rate for Payer: VA VA |
$105.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$381.33 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: BCBS Trust/PPO |
$345.87
|
| Rate for Payer: BCN Commercial |
$327.44
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$364.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$381.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$368.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.86
|
| Rate for Payer: UHC Core |
$353.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.78
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| 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 |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.06
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| 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 Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2.31
|
| Rate for Payer: Priority Health Medicare |
$0.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| 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 Dual Complete DSNP |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: VA VA |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| 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 Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| 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 37.5 MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$69.80
|
|
|
Service Code
|
NDC 65862052730
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$53.94
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.37
|
| Rate for Payer: Priority Health HMO/PPO |
$60.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.35
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: BCBS Trust/PPO |
$240.40
|
| 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 Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: Priority Health HMO/PPO |
$256.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.32
|
| 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
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.23 |
| 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 |
$125.02
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCBS Trust/PPO |
$256.95
|
| Rate for Payer: BCN Commercial |
$243.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| 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 Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health HMO/PPO |
$271.92
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.41
|
| 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 Dual Complete DSNP |
$78.14
|
| Rate for Payer: UHC Exchange |
$78.14
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| 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
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.16 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: BCBS Trust/PPO |
$255.13
|
| Rate for Payer: BCN Commercial |
$241.54
|
| 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: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health HMO/PPO |
$271.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.41
|
| 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
|
$68.97
|
|
|
Service Code
|
NDC 00093738456
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Aetna Commercial |
$58.62
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.55
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$17.24
|
| Rate for Payer: BCBS Trust/PPO |
$56.70
|
| Rate for Payer: BCN Commercial |
$53.62
|
| Rate for Payer: BCN Medicare Advantage |
$17.24
|
| 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: Health Alliance Plan Medicare Advantage |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$62.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.62
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: PACE Senior Care Partners |
$16.38
|
| Rate for Payer: PACE SWMI |
$17.24
|
| Rate for Payer: PHP Commercial |
$58.62
|
| Rate for Payer: PHP Medicare Advantage |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.83
|
| Rate for Payer: Priority Health HMO/PPO |
$60.00
|
| Rate for Payer: Priority Health Medicare |
$17.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.21
|
| Rate for Payer: Railroad Medicare Medicare |
$17.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.69
|
| Rate for Payer: UHC Core |
$57.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.24
|
| Rate for Payer: UHC Exchange |
$17.24
|
| Rate for Payer: UHC Medicare Advantage |
$17.24
|
| Rate for Payer: VA VA |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.73
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: Aetna Medicare |
$76.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.03
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS MAPPO |
$73.62
|
| Rate for Payer: BCBS Trust/PPO |
$242.11
|
| Rate for Payer: BCN Commercial |
$228.97
|
| Rate for Payer: BCN Medicare Advantage |
$73.62
|
| 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: Health Alliance Plan Medicare Advantage |
$73.62
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: PACE Senior Care Partners |
$69.94
|
| Rate for Payer: PACE SWMI |
$73.62
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: PHP Medicare Advantage |
$73.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: Priority Health HMO/PPO |
$256.22
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.32
|
| Rate for Payer: Railroad Medicare Medicare |
$73.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.16
|
| Rate for Payer: UHC Core |
$245.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.62
|
| Rate for Payer: UHC Exchange |
$73.62
|
| Rate for Payer: UHC Medicare Advantage |
$73.62
|
| Rate for Payer: VA VA |
$73.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$68.97
|
|
|
Service Code
|
NDC 00093738456
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.83 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Aetna Commercial |
$58.62
|
| Rate for Payer: BCBS Trust/PPO |
$56.30
|
| 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 Commercial |
$58.62
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: PHP Commercial |
$58.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.83
|
| Rate for Payer: Priority Health HMO/PPO |
$60.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.21
|
| 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
|
OP
|
$69.80
|
|
|
Service Code
|
NDC 65862052730
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$59.33
|
| Rate for Payer: Aetna Medicare |
$18.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.81
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS MAPPO |
$17.45
|
| Rate for Payer: BCBS Trust/PPO |
$57.38
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.45
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$62.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: PACE Senior Care Partners |
$16.58
|
| Rate for Payer: PACE SWMI |
$17.45
|
| Rate for Payer: PHP Commercial |
$59.33
|
| Rate for Payer: PHP Medicare Advantage |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.37
|
| Rate for Payer: Priority Health HMO/PPO |
$60.73
|
| Rate for Payer: Priority Health Medicare |
$17.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$58.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.45
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicare Advantage |
$17.45
|
| Rate for Payer: VA VA |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.35
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$215.73
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.22 |
| Max. Negotiated Rate |
$194.16 |
| Rate for Payer: Aetna Commercial |
$183.37
|
| Rate for Payer: BCBS Trust/PPO |
$176.10
|
| Rate for Payer: BCN Commercial |
$166.72
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$194.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: PHP Commercial |
$183.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO |
$187.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.84
|
| Rate for Payer: UHC Core |
$180.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.80
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$55.57
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.74
|
| Rate for Payer: Priority Health HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
