|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
OP
|
$71.87
|
|
|
Service Code
|
NDC 41616093240
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.59 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna Medicare |
$35.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: BCBS Complete |
$28.75
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$26.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
OP
|
$71.87
|
|
|
Service Code
|
NDC 41616093244
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.59 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna American Axle |
$46.72
|
| Rate for Payer: Aetna Commercial |
$61.09
|
| Rate for Payer: Aetna Medicare |
$35.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.72
|
| Rate for Payer: BCBS Complete |
$28.75
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$50.31
|
| Rate for Payer: Cofinity Commercial |
$61.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$64.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: PHP Commercial |
$61.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: Priority Health SBD |
$45.28
|
| Rate for Payer: UMR Bronson Commercial |
$26.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.90
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,707.74 |
| Max. Negotiated Rate |
$21,902.19 |
| Rate for Payer: Aetna American Axle |
$15,818.25
|
| Rate for Payer: Aetna Commercial |
$20,685.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,818.25
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cofinity Commercial |
$17,035.04
|
| Rate for Payer: Cofinity Commercial |
$20,928.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,035.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Healthscope Commercial |
$21,902.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,035.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,251.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: PHP Commercial |
$20,685.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health SBD |
$15,331.54
|
| Rate for Payer: UMR Bronson Commercial |
$10,707.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,251.83
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$21,902.19 |
| Rate for Payer: Aetna American Axle |
$15,818.25
|
| Rate for Payer: Aetna Commercial |
$20,685.40
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,818.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$60.02
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cofinity Commercial |
$20,928.76
|
| Rate for Payer: Cofinity Commercial |
$17,035.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,035.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$21,902.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,035.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,251.83
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: Nomi Health Commercial |
$65.01
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$20,685.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.05
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow Network |
$51.24
|
| Rate for Payer: Priority Health SBD |
$15,331.54
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.67
|
| Rate for Payer: UHC Exchange |
$41.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.67
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: UMR Bronson Commercial |
$9,004.23
|
| Rate for Payer: VA VA |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,251.83
|
|
|
VENETOCLAX 100 MG TABLET
|
Facility
|
IP
|
$13,484.79
|
|
|
Service Code
|
NDC 00074057630
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,933.31 |
| 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 New Business (MI Preferred) |
$8,765.11
|
| 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 |
$5,933.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,113.59
|
|
|
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 100 MG TABLET
|
Facility
|
IP
|
$481.56
|
|
|
Service Code
|
NDC 00074057611
|
| Hospital Charge Code |
178563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.89 |
| Max. Negotiated Rate |
$433.40 |
| Rate for Payer: Aetna American Axle |
$313.01
|
| Rate for Payer: Aetna Commercial |
$409.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.01
|
| 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 |
$211.89
|
| 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
|
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 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 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
|
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 |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| 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 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 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 |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| 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 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
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$264.20 |
| 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 |
$205.48
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.48
|
| 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 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 |
$264.20 |
| 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: Cofinity Medicare Advantage |
$205.48
|
| 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 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
|
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 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
|
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 |
$264.20 |
| 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: Cofinity Medicare Advantage |
$205.48
|
| 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 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
|
$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
|
$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
|
|
