|
VENETOCLAX 100 MG TABLET
|
Facility
|
OP
|
$13,484.79
|
|
|
Service Code
|
NDC 00074057630
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,989.37 |
| Max. Negotiated Rate |
$12,136.31 |
| Rate for Payer: Aetna American Axle |
$8,765.11
|
| Rate for Payer: Aetna Commercial |
$11,462.07
|
| Rate for Payer: Aetna Medicare |
$6,742.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,765.11
|
| Rate for Payer: BCBS Complete |
$5,393.92
|
| Rate for Payer: Cash Price |
$10,787.83
|
| Rate for Payer: Cofinity Commercial |
$11,596.92
|
| Rate for Payer: Cofinity Commercial |
$9,439.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,439.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,787.83
|
| Rate for Payer: Healthscope Commercial |
$12,136.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,439.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,113.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,462.07
|
| Rate for Payer: PHP Commercial |
$11,462.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,765.11
|
| Rate for Payer: Priority Health SBD |
$8,495.42
|
| Rate for Payer: UMR Bronson Commercial |
$4,989.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,113.59
|
|
|
VENETOCLAX 100 MG TABLET
|
Facility
|
OP
|
$481.56
|
|
|
Service Code
|
NDC 00074057611
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.18 |
| Max. Negotiated Rate |
$433.40 |
| Rate for Payer: Aetna American Axle |
$313.01
|
| Rate for Payer: Aetna Commercial |
$409.33
|
| Rate for Payer: Aetna Medicare |
$240.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.01
|
| Rate for Payer: BCBS Complete |
$192.62
|
| Rate for Payer: Cash Price |
$385.25
|
| Rate for Payer: Cofinity Commercial |
$337.09
|
| Rate for Payer: Cofinity Commercial |
$414.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.25
|
| Rate for Payer: Healthscope Commercial |
$433.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.33
|
| Rate for Payer: PHP Commercial |
$409.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.01
|
| Rate for Payer: Priority Health SBD |
$303.38
|
| Rate for Payer: UMR Bronson Commercial |
$178.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.17
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
OP
|
$96.28
|
|
|
Service Code
|
NDC 00074056111
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$86.65 |
| Rate for Payer: Aetna American Axle |
$62.58
|
| Rate for Payer: Aetna Commercial |
$81.84
|
| Rate for Payer: Aetna Medicare |
$48.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.58
|
| Rate for Payer: BCBS Complete |
$38.51
|
| Rate for Payer: Cash Price |
$77.02
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Cofinity Commercial |
$82.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.02
|
| Rate for Payer: Healthscope Commercial |
$86.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.84
|
| Rate for Payer: PHP Commercial |
$81.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: Priority Health SBD |
$60.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.21
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
IP
|
$674.23
|
|
|
Service Code
|
NDC 00074056114
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$606.81 |
| Rate for Payer: Aetna American Axle |
$438.25
|
| Rate for Payer: Aetna Commercial |
$573.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.25
|
| Rate for Payer: Cash Price |
$539.38
|
| Rate for Payer: Cofinity Commercial |
$471.96
|
| Rate for Payer: Cofinity Commercial |
$579.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.38
|
| Rate for Payer: Healthscope Commercial |
$606.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.10
|
| Rate for Payer: PHP Commercial |
$573.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.25
|
| Rate for Payer: Priority Health SBD |
$424.76
|
| Rate for Payer: UMR Bronson Commercial |
$296.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.67
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
OP
|
$674.23
|
|
|
Service Code
|
NDC 00074056114
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.47 |
| Max. Negotiated Rate |
$606.81 |
| Rate for Payer: Aetna American Axle |
$438.25
|
| Rate for Payer: Aetna Commercial |
$573.10
|
| Rate for Payer: Aetna Medicare |
$337.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.25
|
| Rate for Payer: BCBS Complete |
$269.69
|
| Rate for Payer: Cash Price |
$539.38
|
| Rate for Payer: Cofinity Commercial |
$471.96
|
| Rate for Payer: Cofinity Commercial |
$579.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.38
|
| Rate for Payer: Healthscope Commercial |
$606.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.10
|
| Rate for Payer: PHP Commercial |
$573.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.25
|
| Rate for Payer: Priority Health SBD |
$424.76
|
| Rate for Payer: UMR Bronson Commercial |
$249.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.67
|
|
|
VENETOCLAX 10 MG TABLET
|
Facility
|
IP
|
$96.28
|
|
|
Service Code
|
NDC 00074056111
|
| Hospital Charge Code |
178561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.36 |
| Max. Negotiated Rate |
$86.65 |
| Rate for Payer: Aetna American Axle |
$62.58
|
| Rate for Payer: Aetna Commercial |
$81.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.58
|
| Rate for Payer: Cash Price |
$77.02
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Cofinity Commercial |
$82.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.02
|
| Rate for Payer: Healthscope Commercial |
$86.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.84
|
| Rate for Payer: PHP Commercial |
$81.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: Priority Health SBD |
$60.66
|
| Rate for Payer: UMR Bronson Commercial |
$42.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.21
|
|
|
VENETOCLAX 50 MG TABLET
|
Facility
|
OP
|
$240.84
|
|
|
Service Code
|
NDC 00074056611
|
| Hospital Charge Code |
178562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.11 |
| Max. Negotiated Rate |
$216.76 |
| Rate for Payer: Aetna American Axle |
$156.55
|
| Rate for Payer: Aetna Commercial |
$204.71
|
| Rate for Payer: Aetna Medicare |
$120.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.55
|
| Rate for Payer: BCBS Complete |
$96.34
|
| Rate for Payer: Cash Price |
$192.67
|
| Rate for Payer: Cofinity Commercial |
$168.59
|
| Rate for Payer: Cofinity Commercial |
$207.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.67
|
| Rate for Payer: Healthscope Commercial |
$216.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.71
|
| Rate for Payer: PHP Commercial |
$204.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.55
|
| Rate for Payer: Priority Health SBD |
$151.73
|
| Rate for Payer: UMR Bronson Commercial |
$89.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.63
|
|
|
VENETOCLAX 50 MG TABLET
|
Facility
|
IP
|
$240.84
|
|
|
Service Code
|
NDC 00074056611
|
| Hospital Charge Code |
178562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.97 |
| Max. Negotiated Rate |
$216.76 |
| Rate for Payer: Aetna American Axle |
$156.55
|
| Rate for Payer: Aetna Commercial |
$204.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.55
|
| Rate for Payer: Cash Price |
$192.67
|
| Rate for Payer: Cofinity Commercial |
$168.59
|
| Rate for Payer: Cofinity Commercial |
$207.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.67
|
| Rate for Payer: Healthscope Commercial |
$216.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.71
|
| Rate for Payer: PHP Commercial |
$204.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.55
|
| Rate for Payer: Priority Health SBD |
$151.73
|
| Rate for Payer: UMR Bronson Commercial |
$105.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.63
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$264.19 |
| Rate for Payer: Aetna American Axle |
$190.81
|
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna Medicare |
$146.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UMR Bronson Commercial |
$108.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.16
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$264.19 |
| 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 |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| 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
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
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 Commercial |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.85
|
| 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: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| 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 |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.85
|
| 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: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| 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
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 62332001031
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$264.19 |
| Rate for Payer: Aetna American Axle |
$190.81
|
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna Medicare |
$146.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UMR Bronson Commercial |
$108.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.16
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 57237017401
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| 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 Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 57664039488
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.07 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$150.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: BCBS Complete |
$120.08
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.14
|
| 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: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$111.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
VENLAFAXINE 50 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 62332001031
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$264.19 |
| 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 |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| 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
|
$300.20
|
|
|
Service Code
|
NDC 57664039488
|
| 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: Cofinity Medicare Advantage |
$210.14
|
| 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: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| 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
|
$300.80
|
|
|
Service Code
|
NDC 57237017401
|
| 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: Cofinity Medicare Advantage |
$210.56
|
| 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 Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| 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
|
$323.00
|
|
|
Service Code
|
NDC 68382002001
|
| 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: Cofinity Medicare Advantage |
$226.10
|
| 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 Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| 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
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 68382002001
|
| Hospital Charge Code |
12204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.51 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| 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 Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$119.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$357.12
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Commercial |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.55
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.13
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UMR Bronson Commercial |
$157.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 57237017501
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 57237017501
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 68382002101
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| 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 Commercial |
$276.17
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.19
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 68084085611
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health SBD |
$2.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
