|
VENLAFAXINE 50 MG TABLET
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
NDC 57237017401
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna American Axle |
$149.69
|
| Rate for Payer: Aetna Commercial |
$195.75
|
| Rate for Payer: Aetna Medicare |
$115.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.69
|
| Rate for Payer: BCBS Complete |
$92.12
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Advantage |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.72
|
| Rate for Payer: PHP Commercial |
$195.75
|
| Rate for Payer: Priority Health SBD |
$145.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.69
|
| Rate for Payer: UHC Core |
$119.99
|
| Rate for Payer: UHC Exchange |
$90.51
|
| Rate for Payer: UMR Bronson Commercial |
$85.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 68382002001
|
| 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 Advantage |
$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 Commercial |
$255.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PHP Commercial |
$255.17
|
| 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
|
$286.90
|
|
|
Service Code
|
NDC 62332001031
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.49
|
| Rate for Payer: Aetna Commercial |
$243.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.49
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Advantage |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: PHP Commercial |
$243.87
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UMR Bronson Commercial |
$126.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
|
OP
|
$286.90
|
|
|
Service Code
|
NDC 62332001031
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna American Axle |
$186.49
|
| Rate for Payer: Aetna Commercial |
$243.87
|
| Rate for Payer: Aetna Medicare |
$143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.49
|
| Rate for Payer: BCBS Complete |
$114.76
|
| Rate for Payer: Cash Price |
$229.52
|
| Rate for Payer: Cofinity Advantage |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$246.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$258.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.18
|
| Rate for Payer: PHP Commercial |
$243.87
|
| Rate for Payer: Priority Health SBD |
$180.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.49
|
| Rate for Payer: UHC Core |
$149.47
|
| Rate for Payer: UHC Exchange |
$112.75
|
| Rate for Payer: UMR Bronson Commercial |
$106.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.18
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 68084085611
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$439.20
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$395.28 |
| Rate for Payer: Aetna American Axle |
$285.48
|
| Rate for Payer: Aetna Commercial |
$373.32
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.48
|
| Rate for Payer: BCBS Complete |
$175.68
|
| Rate for Payer: Cash Price |
$351.36
|
| Rate for Payer: Cofinity Advantage |
$307.44
|
| Rate for Payer: Cofinity Commercial |
$377.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.36
|
| Rate for Payer: Healthscope Commercial |
$395.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.40
|
| Rate for Payer: PHP Commercial |
$373.32
|
| Rate for Payer: Priority Health SBD |
$276.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.48
|
| Rate for Payer: UHC Core |
$228.82
|
| Rate for Payer: UHC Exchange |
$172.61
|
| Rate for Payer: UMR Bronson Commercial |
$162.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.40
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$439.20
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$395.28 |
| Rate for Payer: Aetna American Axle |
$285.48
|
| Rate for Payer: Aetna Commercial |
$373.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.48
|
| Rate for Payer: Cash Price |
$351.36
|
| Rate for Payer: Cofinity Advantage |
$307.44
|
| Rate for Payer: Cofinity Commercial |
$377.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.36
|
| Rate for Payer: Healthscope Commercial |
$395.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.40
|
| Rate for Payer: PHP Commercial |
$373.32
|
| Rate for Payer: Priority Health SBD |
$276.70
|
| Rate for Payer: UMR Bronson Commercial |
$193.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.40
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 57237017501
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 68084085611
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Advantage |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.30
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.86
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Exchange |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 57237017501
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.47
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.47
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Advantage |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.62
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health SBD |
$133.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.47
|
| Rate for Payer: UHC Core |
$110.19
|
| Rate for Payer: UHC Exchange |
$83.12
|
| Rate for Payer: UMR Bronson Commercial |
$78.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 68382002101
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.86
|
| Rate for Payer: UHC Core |
$165.81
|
| Rate for Payer: UHC Exchange |
$125.07
|
| Rate for Payer: UMR Bronson Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 68382002101
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UMR Bronson Commercial |
$140.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna American Axle |
$1.72
|
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| 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 |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.38
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$264.48
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna American Axle |
$171.91
|
| Rate for Payer: Aetna Commercial |
$224.81
|
| Rate for Payer: Aetna Medicare |
$132.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.91
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cofinity Advantage |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$227.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.58
|
| Rate for Payer: Healthscope Commercial |
$238.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.36
|
| Rate for Payer: PHP Commercial |
$224.81
|
| Rate for Payer: Priority Health SBD |
$166.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.91
|
| Rate for Payer: UHC Core |
$137.79
|
| Rate for Payer: UHC Exchange |
$103.94
|
| Rate for Payer: UMR Bronson Commercial |
$97.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.36
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$264.48
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.37 |
| Max. Negotiated Rate |
$238.03 |
| Rate for Payer: Aetna American Axle |
$171.91
|
| Rate for Payer: Aetna Commercial |
$224.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.91
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cofinity Advantage |
$185.14
|
| Rate for Payer: Cofinity Commercial |
$227.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.58
|
| Rate for Payer: Healthscope Commercial |
$238.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.36
|
| Rate for Payer: PHP Commercial |
$224.81
|
| Rate for Payer: Priority Health SBD |
$166.62
|
| Rate for Payer: UMR Bronson Commercial |
$116.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.36
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| 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 Advantage |
$1.85
|
| 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 |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| 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 ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$222.08
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna American Axle |
$144.35
|
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.35
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Advantage |
$155.46
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: Priority Health SBD |
$139.91
|
| Rate for Payer: UMR Bronson Commercial |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.56
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$75.44
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.19 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna American Axle |
$49.04
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.04
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cofinity Advantage |
$52.81
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.35
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health SBD |
$47.53
|
| Rate for Payer: UMR Bronson Commercial |
$33.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.58
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$75.44
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Aetna American Axle |
$49.04
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.04
|
| Rate for Payer: BCBS Complete |
$30.18
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cofinity Advantage |
$52.81
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.35
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.58
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health SBD |
$47.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.04
|
| Rate for Payer: UHC Core |
$39.30
|
| Rate for Payer: UHC Exchange |
$29.65
|
| Rate for Payer: UMR Bronson Commercial |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.58
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.34 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,982.13
|
|
|
Service Code
|
NDC 00008083321
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$733.39 |
| Max. Negotiated Rate |
$1,783.92 |
| Rate for Payer: Aetna American Axle |
$1,288.38
|
| Rate for Payer: Aetna Commercial |
$1,684.81
|
| Rate for Payer: Aetna Medicare |
$991.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.38
|
| Rate for Payer: BCBS Complete |
$792.85
|
| Rate for Payer: Cash Price |
$1,585.70
|
| Rate for Payer: Cofinity Advantage |
$1,387.49
|
| Rate for Payer: Cofinity Commercial |
$1,704.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,585.70
|
| Rate for Payer: Healthscope Commercial |
$1,783.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,387.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,486.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,585.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,486.60
|
| Rate for Payer: PHP Commercial |
$1,684.81
|
| Rate for Payer: Priority Health SBD |
$1,248.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,288.38
|
| Rate for Payer: UHC Core |
$1,032.69
|
| Rate for Payer: UHC Exchange |
$778.98
|
| Rate for Payer: UMR Bronson Commercial |
$733.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,486.60
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$222.08
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$199.87 |
| Rate for Payer: Aetna American Axle |
$144.35
|
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna Medicare |
$111.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.35
|
| Rate for Payer: BCBS Complete |
$88.83
|
| Rate for Payer: Cash Price |
$177.66
|
| Rate for Payer: Cofinity Advantage |
$155.46
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.66
|
| Rate for Payer: Healthscope Commercial |
$199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.56
|
| Rate for Payer: PHP Commercial |
$188.77
|
| Rate for Payer: Priority Health SBD |
$139.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.35
|
| Rate for Payer: UHC Core |
$115.70
|
| Rate for Payer: UHC Exchange |
$87.28
|
| Rate for Payer: UMR Bronson Commercial |
$82.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.56
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$353.97
|
|
|
Service Code
|
NDC 71921017309
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$318.57 |
| Rate for Payer: Aetna American Axle |
$230.08
|
| Rate for Payer: Aetna Commercial |
$300.87
|
| Rate for Payer: Aetna Medicare |
$176.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.08
|
| Rate for Payer: BCBS Complete |
$141.59
|
| Rate for Payer: Cash Price |
$283.18
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$283.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.48
|
| Rate for Payer: PHP Commercial |
$300.87
|
| Rate for Payer: Priority Health SBD |
$223.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.08
|
| Rate for Payer: UHC Core |
$184.42
|
| Rate for Payer: UHC Exchange |
$139.11
|
| Rate for Payer: UMR Bronson Commercial |
$130.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.48
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,982.13
|
|
|
Service Code
|
NDC 00008083321
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$872.14 |
| Max. Negotiated Rate |
$1,783.92 |
| Rate for Payer: Aetna American Axle |
$1,288.38
|
| Rate for Payer: Aetna Commercial |
$1,684.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.38
|
| Rate for Payer: Cash Price |
$1,585.70
|
| Rate for Payer: Cofinity Advantage |
$1,387.49
|
| Rate for Payer: Cofinity Commercial |
$1,704.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,585.70
|
| Rate for Payer: Healthscope Commercial |
$1,783.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,387.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,486.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,486.60
|
| Rate for Payer: PHP Commercial |
$1,684.81
|
| Rate for Payer: Priority Health SBD |
$1,248.74
|
| Rate for Payer: UMR Bronson Commercial |
$872.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,486.60
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$226.58
|
|
|
Service Code
|
NDC 00093738598
|
| 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 Advantage |
$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 Commercial |
$192.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.94
|
| Rate for Payer: PHP Commercial |
$192.59
|
| 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
|
|
