|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$50,768.12
|
|
|
Service Code
|
MS-DRG 263
|
| Min. Negotiated Rate |
$21,169.27 |
| Max. Negotiated Rate |
$50,768.12 |
| Rate for Payer: Aetna Medicare |
$23,174.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,854.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,854.30
|
| Rate for Payer: BCBS MAPPO |
$22,283.44
|
| Rate for Payer: BCBS Trust/PPO |
$50,768.12
|
| Rate for Payer: BCN Medicare Advantage |
$22,283.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,283.44
|
| Rate for Payer: Mclaren Medicare |
$22,283.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,397.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,625.96
|
| Rate for Payer: PACE Medicare |
$21,169.27
|
| Rate for Payer: PACE SWMI |
$22,283.44
|
| Rate for Payer: PHP Medicare Advantage |
$22,283.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,541.39
|
| Rate for Payer: Priority Health Medicare |
$22,283.44
|
| Rate for Payer: Priority Health Narrow Network |
$32,433.11
|
| Rate for Payer: Railroad Medicare Medicare |
$22,283.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,095.60
|
| Rate for Payer: UHC Core |
$35,337.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,283.44
|
| Rate for Payer: UHC Exchange |
$28,093.79
|
| Rate for Payer: UHC Medicare Advantage |
$22,951.94
|
| Rate for Payer: VA VA |
$22,283.44
|
|
|
VENETOCLAX 100 MG TABLET
|
Facility
|
IP
|
$13,179.89
|
|
|
Service Code
|
NDC 0074-0576-30
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,799.15 |
| Max. Negotiated Rate |
$11,861.90 |
| Rate for Payer: Aetna American Axle |
$8,566.93
|
| Rate for Payer: Aetna Commercial |
$11,202.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,566.93
|
| Rate for Payer: Cash Price |
$10,543.91
|
| Rate for Payer: Cofinity Commercial |
$11,334.71
|
| Rate for Payer: Cofinity Commercial |
$9,225.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,543.91
|
| Rate for Payer: Healthscope Commercial |
$11,861.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,225.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,884.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,202.91
|
| Rate for Payer: PHP Commercial |
$11,202.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,225.92
|
| Rate for Payer: Priority Health SBD |
$8,303.33
|
| Rate for Payer: UMR Bronson Commercial |
$5,799.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,884.92
|
|
|
VENETOCLAX 100 MG TABLET
|
Facility
|
IP
|
$470.68
|
|
|
Service Code
|
NDC 0074-0576-11
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.10 |
| Max. Negotiated Rate |
$423.61 |
| Rate for Payer: Aetna American Axle |
$305.94
|
| Rate for Payer: Aetna Commercial |
$400.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.94
|
| Rate for Payer: Cash Price |
$376.54
|
| Rate for Payer: Cofinity Commercial |
$329.48
|
| Rate for Payer: Cofinity Commercial |
$404.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.54
|
| Rate for Payer: Healthscope Commercial |
$423.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.08
|
| Rate for Payer: PHP Commercial |
$400.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.48
|
| Rate for Payer: Priority Health SBD |
$296.53
|
| Rate for Payer: UMR Bronson Commercial |
$207.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.01
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
IP
|
$94.13
|
|
|
Service Code
|
NDC 0074-0561-11
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$84.72 |
| Rate for Payer: Aetna American Axle |
$61.18
|
| Rate for Payer: Aetna Commercial |
$80.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.18
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cofinity Commercial |
$65.89
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.30
|
| Rate for Payer: Healthscope Commercial |
$84.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.01
|
| Rate for Payer: PHP Commercial |
$80.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.89
|
| Rate for Payer: Priority Health SBD |
$59.30
|
| Rate for Payer: UMR Bronson Commercial |
$41.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.60
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
NDC 0074-0561-14
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.96 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Aetna American Axle |
$428.35
|
| Rate for Payer: Aetna Commercial |
$560.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.35
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cofinity Commercial |
$461.30
|
| Rate for Payer: Cofinity Commercial |
$566.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.20
|
| Rate for Payer: Healthscope Commercial |
$593.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$560.15
|
| Rate for Payer: PHP Commercial |
$560.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.30
|
| Rate for Payer: Priority Health SBD |
$415.17
|
| Rate for Payer: UMR Bronson Commercial |
$289.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.25
|
|
|
VENETOCLAX 50 MG TABLET
|
Facility
|
IP
|
$235.36
|
|
|
Service Code
|
NDC 0074-0566-11
|
| Hospital Charge Code |
178562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$211.82 |
| Rate for Payer: Aetna American Axle |
$152.98
|
| Rate for Payer: Aetna Commercial |
$200.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.98
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cofinity Commercial |
$164.75
|
| Rate for Payer: Cofinity Commercial |
$202.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Healthscope Commercial |
$211.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.06
|
| Rate for Payer: PHP Commercial |
$200.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.75
|
| Rate for Payer: Priority Health SBD |
$148.28
|
| Rate for Payer: UMR Bronson Commercial |
$103.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.52
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 68382-019-01
|
| Hospital Charge Code |
12207
|
|
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 37.5 MG TABLET
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079-480-01
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna American Axle |
$1.72
|
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
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 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
|
$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
|
$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 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
|
$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 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 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 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 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
|
$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 |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: 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
|
$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
|
$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
|
$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
|
$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
|
|
