|
VENLAFAXINE 50 MG TABLET
|
Facility
IP
|
$300.20
|
|
|
Service Code
|
NDC 57664-394-88
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.14
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
IP
|
$323.00
|
|
|
Service Code
|
NDC 68382-020-01
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
IP
|
$293.55
|
|
|
Service Code
|
NDC 62332-010-31
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$264.20 |
| Rate for Payer: Aetna American Axle |
$190.81
|
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$205.48
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.48
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UMR Bronson Commercial |
$129.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.16
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
IP
|
$300.80
|
|
|
Service Code
|
NDC 57237-174-01
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.56
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$132.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
IP
|
$348.48
|
|
|
Service Code
|
NDC 68084-856-01
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.33 |
| Max. Negotiated Rate |
$313.63 |
| Rate for Payer: Aetna American Axle |
$226.51
|
| Rate for Payer: Aetna Commercial |
$296.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.51
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Commercial |
$243.94
|
| Rate for Payer: Cofinity Commercial |
$299.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.78
|
| Rate for Payer: Healthscope Commercial |
$313.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.21
|
| Rate for Payer: PHP Commercial |
$296.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.94
|
| Rate for Payer: Priority Health SBD |
$219.54
|
| Rate for Payer: UMR Bronson Commercial |
$153.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.36
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
IP
|
$289.05
|
|
|
Service Code
|
NDC 57237-175-01
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.34
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
IP
|
$324.90
|
|
|
Service Code
|
NDC 68382-021-01
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.18
|
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.43
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
IP
|
$3.49
|
|
|
Service Code
|
NDC 68084-856-11
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.97
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.20
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
NDC 68084-698-11
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna American Axle |
$2.73
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.73
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$3.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.57
|
| Rate for Payer: PHP Commercial |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.15
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$419.90
|
|
|
Service Code
|
NDC 68084-698-01
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.76 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna American Axle |
$272.94
|
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$293.93
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.92
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.92
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.93
|
| Rate for Payer: Priority Health SBD |
$264.54
|
| Rate for Payer: UMR Bronson Commercial |
$184.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.92
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$209.39
|
|
|
Service Code
|
NDC 65862-528-90
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Aetna American Axle |
$136.10
|
| Rate for Payer: Aetna Commercial |
$177.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cofinity Commercial |
$146.57
|
| Rate for Payer: Cofinity Commercial |
$180.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.51
|
| Rate for Payer: Healthscope Commercial |
$188.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.98
|
| Rate for Payer: PHP Commercial |
$177.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.57
|
| Rate for Payer: Priority Health SBD |
$131.92
|
| Rate for Payer: UMR Bronson Commercial |
$92.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.04
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$353.97
|
|
|
Service Code
|
NDC 71921-173-09
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$318.57 |
| Rate for Payer: Aetna American Axle |
$230.08
|
| Rate for Payer: Aetna Commercial |
$300.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.08
|
| Rate for Payer: Cash Price |
$283.18
|
| Rate for Payer: Cofinity Commercial |
$247.78
|
| Rate for Payer: Cofinity Commercial |
$304.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.18
|
| Rate for Payer: Healthscope Commercial |
$318.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.87
|
| Rate for Payer: PHP Commercial |
$300.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.78
|
| Rate for Payer: Priority Health SBD |
$223.00
|
| Rate for Payer: UMR Bronson Commercial |
$155.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.48
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$464.55
|
|
|
Service Code
|
NDC 68084-709-01
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Aetna American Axle |
$301.96
|
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.96
|
| Rate for Payer: Cash Price |
$371.64
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$399.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.64
|
| Rate for Payer: Healthscope Commercial |
$418.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.87
|
| Rate for Payer: PHP Commercial |
$394.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.18
|
| Rate for Payer: Priority Health SBD |
$292.67
|
| Rate for Payer: UMR Bronson Commercial |
$204.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.41
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$4.65
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.95
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$296.40
|
|
|
Service Code
|
NDC 0904-6469-61
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Aetna American Axle |
$192.66
|
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.66
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$207.48
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$207.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$186.73
|
| Rate for Payer: UMR Bronson Commercial |
$130.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$226.58
|
|
|
Service Code
|
NDC 0093-7385-98
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.70 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna American Axle |
$147.28
|
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$203.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.59
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.61
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.94
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$70.50
|
|
|
Service Code
|
NDC 65862-528-30
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.82
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$1,884.12
|
|
|
Service Code
|
NDC 0008-0833-21
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$829.01 |
| Max. Negotiated Rate |
$1,695.71 |
| Rate for Payer: Aetna American Axle |
$1,224.68
|
| Rate for Payer: Aetna Commercial |
$1,601.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,224.68
|
| Rate for Payer: Cash Price |
$1,507.30
|
| Rate for Payer: Cofinity Commercial |
$1,318.88
|
| Rate for Payer: Cofinity Commercial |
$1,620.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.30
|
| Rate for Payer: Healthscope Commercial |
$1,695.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,318.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,601.50
|
| Rate for Payer: PHP Commercial |
$1,601.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,318.88
|
| Rate for Payer: Priority Health SBD |
$1,187.00
|
| Rate for Payer: UMR Bronson Commercial |
$829.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.09
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$406.13
|
|
|
Service Code
|
NDC 13668-019-90
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$365.52 |
| Rate for Payer: Aetna American Axle |
$263.98
|
| Rate for Payer: Aetna Commercial |
$345.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.98
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cofinity Commercial |
$284.29
|
| Rate for Payer: Cofinity Commercial |
$349.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.90
|
| Rate for Payer: Healthscope Commercial |
$365.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.21
|
| Rate for Payer: PHP Commercial |
$345.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.29
|
| Rate for Payer: Priority Health SBD |
$255.86
|
| Rate for Payer: UMR Bronson Commercial |
$178.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.60
|
|
|
VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING
|
Facility
OP
|
$1,859.63
|
|
|
Service Code
|
CPT 36500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.53 |
| Max. Negotiated Rate |
$1,859.63 |
| Rate for Payer: BCBS Trust/PPO |
$1,859.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$174.53
|
|
|
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
|
Facility
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 69424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.59 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,042.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.55
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$59.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
OP
|
$66.78
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna American Axle |
$43.41
|
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: BCBS Complete |
$26.71
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$46.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.76
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health SBD |
$42.07
|
| Rate for Payer: UMR Bronson Commercial |
$24.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.08
|
|
|
VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$66.78
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
32309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$60.10 |
| Rate for Payer: Aetna American Axle |
$43.41
|
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Cofinity Commercial |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.42
|
| Rate for Payer: Healthscope Commercial |
$60.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.76
|
| Rate for Payer: PHP Commercial |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health SBD |
$42.07
|
| Rate for Payer: UMR Bronson Commercial |
$29.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.08
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
IP
|
$42,714.27
|
|
|
Service Code
|
MS-DRG 032
|
| Min. Negotiated Rate |
$16,254.12 |
| Max. Negotiated Rate |
$42,714.27 |
| Rate for Payer: Aetna Medicare |
$17,793.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,387.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,387.00
|
| Rate for Payer: BCBS MAPPO |
$17,109.60
|
| Rate for Payer: BCBS Trust/PPO |
$42,714.27
|
| Rate for Payer: BCN Medicare Advantage |
$17,109.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,109.60
|
| Rate for Payer: Mclaren Medicare |
$17,109.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,965.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,676.04
|
| Rate for Payer: PACE Medicare |
$16,254.12
|
| Rate for Payer: PACE SWMI |
$17,109.60
|
| Rate for Payer: PHP Medicare Advantage |
$17,109.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,906.86
|
| Rate for Payer: Priority Health Medicare |
$17,109.60
|
| Rate for Payer: Priority Health Narrow Network |
$24,725.49
|
| Rate for Payer: Railroad Medicare Medicare |
$17,109.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,854.07
|
| Rate for Payer: UHC Core |
$26,939.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,109.60
|
| Rate for Payer: UHC Exchange |
$21,417.39
|
| Rate for Payer: UHC Medicare Advantage |
$17,622.89
|
| Rate for Payer: VA VA |
$17,109.60
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
IP
|
$99,561.10
|
|
|
Service Code
|
MS-DRG 031
|
| Min. Negotiated Rate |
$30,623.27 |
| Max. Negotiated Rate |
$99,561.10 |
| Rate for Payer: Aetna Medicare |
$33,524.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,293.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,293.78
|
| Rate for Payer: BCBS MAPPO |
$32,235.02
|
| Rate for Payer: BCBS Trust/PPO |
$99,561.10
|
| Rate for Payer: BCN Medicare Advantage |
$32,235.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,235.02
|
| Rate for Payer: Mclaren Medicare |
$32,235.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,846.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,070.27
|
| Rate for Payer: PACE Medicare |
$30,623.27
|
| Rate for Payer: PACE SWMI |
$32,235.02
|
| Rate for Payer: PHP Medicare Advantage |
$32,235.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59,072.88
|
| Rate for Payer: Priority Health Medicare |
$32,235.02
|
| Rate for Payer: Priority Health Narrow Network |
$47,258.30
|
| Rate for Payer: Railroad Medicare Medicare |
$32,235.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,794.62
|
| Rate for Payer: UHC Core |
$51,490.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$32,235.02
|
| Rate for Payer: UHC Exchange |
$40,935.47
|
| Rate for Payer: UHC Medicare Advantage |
$33,202.07
|
| Rate for Payer: VA VA |
$32,235.02
|
|
