|
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
|
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 |
$317.77
|
| 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 |
$317.77
|
|
|
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
|
$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 |
$317.77
|
| 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 |
$317.77
|
|
|
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
|
$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
|
$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
|
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
|
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
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.43 |
| 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 |
$191.43
|
| Rate for Payer: Priority Health HMO/PPO |
$256.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.31
|
| 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
|
$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
|
$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 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
|
$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 |
$191.43
|
| Rate for Payer: Priority Health HMO/PPO |
$256.21
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.31
|
| 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 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.47
|
| Rate for Payer: BCBS Complete |
$28.76
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$55.91
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| 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: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: PACE Senior Care Partners |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.74
|
| Rate for Payer: Priority Health HMO/PPO |
$62.56
|
| Rate for Payer: Priority Health Medicare |
$18.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.18
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.28
|
| Rate for Payer: UHC Core |
$60.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: VA VA |
$17.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
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 |
$196.37 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: BCBS Trust/PPO |
$246.60
|
| Rate for Payer: BCN Commercial |
$233.46
|
| 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: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| 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
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: BCBS Trust/PPO |
$241.95
|
| Rate for Payer: BCN Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: Priority Health HMO/PPO |
$257.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.83
|
| Rate for Payer: UHC Core |
$247.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.75 |
| 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 |
$120.84
|
| Rate for Payer: BCBS MAPPO |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$234.88
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| 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 Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| 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 Dual Complete DSNP |
$75.53
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicare Advantage |
$75.53
|
| Rate for Payer: VA VA |
$75.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
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
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Medicare |
$77.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.62
|
| Rate for Payer: BCBS Complete |
$118.56
|
| Rate for Payer: BCBS MAPPO |
$74.10
|
| Rate for Payer: BCBS Trust/PPO |
$243.67
|
| Rate for Payer: BCN Commercial |
$230.45
|
| Rate for Payer: BCN Medicare Advantage |
$74.10
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: PACE Senior Care Partners |
$70.39
|
| Rate for Payer: PACE SWMI |
$74.10
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: PHP Medicare Advantage |
$74.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: Priority Health HMO/PPO |
$257.87
|
| Rate for Payer: Priority Health Medicare |
$74.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.59
|
| Rate for Payer: Railroad Medicare Medicare |
$74.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.83
|
| Rate for Payer: UHC Core |
$247.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.10
|
| Rate for Payer: UHC Exchange |
$74.10
|
| Rate for Payer: UHC Medicare Advantage |
$74.10
|
| Rate for Payer: VA VA |
$74.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$463.60
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$417.24 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Medicare |
$120.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.88
|
| Rate for Payer: BCBS Complete |
$185.44
|
| Rate for Payer: BCBS MAPPO |
$115.90
|
| Rate for Payer: BCBS Trust/PPO |
$381.13
|
| Rate for Payer: BCN Commercial |
$360.45
|
| Rate for Payer: BCN Medicare Advantage |
$115.90
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cofinity Commercial |
$398.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.90
|
| Rate for Payer: Healthscope Commercial |
$417.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.06
|
| Rate for Payer: Nomi Health Commercial |
$380.15
|
| Rate for Payer: PACE Senior Care Partners |
$110.11
|
| Rate for Payer: PACE SWMI |
$115.90
|
| Rate for Payer: PHP Commercial |
$394.06
|
| Rate for Payer: PHP Medicare Advantage |
$115.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.34
|
| Rate for Payer: Priority Health HMO/PPO |
$403.33
|
| Rate for Payer: Priority Health Medicare |
$117.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.61
|
| Rate for Payer: Railroad Medicare Medicare |
$115.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.97
|
| Rate for Payer: UHC Core |
$387.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.90
|
| Rate for Payer: UHC Exchange |
$115.90
|
| Rate for Payer: UHC Medicare Advantage |
$115.90
|
| Rate for Payer: VA VA |
$115.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.70
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.45
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS MAPPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.61
|
| Rate for Payer: BCN Medicare Advantage |
$1.16
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: PACE Senior Care Partners |
$1.10
|
| Rate for Payer: PACE SWMI |
$1.16
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.16
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicare Advantage |
$1.16
|
| Rate for Payer: VA VA |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
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
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$194.16 |
| Rate for Payer: Aetna Commercial |
$183.37
|
| Rate for Payer: Aetna Medicare |
$56.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.42
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: BCBS MAPPO |
$53.93
|
| Rate for Payer: BCBS Trust/PPO |
$177.35
|
| Rate for Payer: BCN Commercial |
$167.73
|
| Rate for Payer: BCN Medicare Advantage |
$53.93
|
| 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: Health Alliance Plan Medicare Advantage |
$53.93
|
| Rate for Payer: Healthscope Commercial |
$194.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: PACE Senior Care Partners |
$51.24
|
| Rate for Payer: PACE SWMI |
$53.93
|
| Rate for Payer: PHP Commercial |
$183.37
|
| Rate for Payer: PHP Medicare Advantage |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO |
$187.69
|
| Rate for Payer: Priority Health Medicare |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.54
|
| Rate for Payer: Railroad Medicare Medicare |
$53.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.84
|
| Rate for Payer: UHC Core |
$180.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.93
|
| Rate for Payer: UHC Exchange |
$53.93
|
| Rate for Payer: UHC Medicare Advantage |
$53.93
|
| Rate for Payer: VA VA |
$53.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.80
|
|
