|
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 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
|
$3.58
|
|
|
Service Code
|
NDC 68084085611
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| 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 |
$2.68
|
| 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 |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
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
|
$357.12
|
|
|
Service Code
|
NDC 68084085601
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna Medicare |
$178.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: BCBS Complete |
$142.85
|
| 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 |
$132.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 68382002101
|
| Hospital Charge Code |
12206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.18
|
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: 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 |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
VENLAFAXINE 75 MG TABLET
|
Facility
|
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 |
$211.18
|
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| 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 |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| 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 |
$2.68
|
| 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 |
$2.68
|
|
|
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 ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna American Axle |
$2.84
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.69 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna American Axle |
$284.05
|
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Medicare |
$218.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
| Rate for Payer: UMR Bronson Commercial |
$161.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 68084069811
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna American Axle |
$2.84
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna American Axle |
$284.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.05
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Commercial |
$375.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.60
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.45
|
| Rate for Payer: PHP Commercial |
$371.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.05
|
| Rate for Payer: Priority Health SBD |
$275.31
|
| Rate for Payer: UMR Bronson Commercial |
$192.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.75
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$35.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: BCBS Complete |
$28.76
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.74
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$463.60
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.98 |
| Max. Negotiated Rate |
$417.24 |
| Rate for Payer: Aetna American Axle |
$301.34
|
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.34
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cofinity Commercial |
$324.52
|
| Rate for Payer: Cofinity Commercial |
$398.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.88
|
| Rate for Payer: Healthscope Commercial |
$417.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.06
|
| Rate for Payer: PHP Commercial |
$394.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.34
|
| Rate for Payer: Priority Health SBD |
$292.07
|
| Rate for Payer: UMR Bronson Commercial |
$203.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.70
|
|
|
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 Commercial |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.61
|
| 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: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.28
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.94
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$266.76 |
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.48
|
| Rate for Payer: Aetna American Axle |
$192.66
|
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Medicare |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.66
|
| Rate for Payer: BCBS Complete |
$118.56
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$207.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: Priority Health SBD |
$186.73
|
| Rate for Payer: UMR Bronson Commercial |
$109.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.30
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 65862052830
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.74
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$406.13
|
|
|
Service Code
|
NDC 13668001990
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$365.52 |
| Rate for Payer: Aetna American Axle |
$263.98
|
| Rate for Payer: Aetna Commercial |
$345.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.98
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cofinity Commercial |
$284.29
|
| Rate for Payer: Cofinity Commercial |
$349.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.90
|
| Rate for Payer: Healthscope Commercial |
$365.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.21
|
| Rate for Payer: PHP Commercial |
$345.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.98
|
| Rate for Payer: Priority Health SBD |
$255.86
|
| Rate for Payer: UMR Bronson Commercial |
$178.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.60
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$194.16 |
| Rate for Payer: Aetna American Axle |
$140.22
|
| Rate for Payer: Aetna Commercial |
$183.37
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.22
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$194.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: PHP Commercial |
$183.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health SBD |
$135.91
|
| Rate for Payer: UMR Bronson Commercial |
$79.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.80
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$226.58
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna American Axle |
$147.28
|
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna Medicare |
$113.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.61
|
| 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: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.28
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UMR Bronson Commercial |
$83.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.94
|
|
|
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 |
$991.06
|
| 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 Commercial |
$1,387.49
|
| Rate for Payer: Cofinity Commercial |
$1,704.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,387.49
|
| 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: PHP Commercial |
$1,684.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.38
|
| Rate for Payer: Priority Health SBD |
$1,248.74
|
| 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
|
IP
|
$353.97
|
|
|
Service Code
|
NDC 71921017309
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$318.57 |
| Rate for Payer: Aetna American Axle |
$230.08
|
| Rate for Payer: Aetna Commercial |
$300.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.08
|
| Rate for Payer: Cash Price |
$283.18
|
| Rate for Payer: Cofinity Commercial |
$247.78
|
| Rate for Payer: Cofinity Commercial |
$304.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.18
|
| Rate for Payer: Healthscope Commercial |
$318.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.87
|
| Rate for Payer: PHP Commercial |
$300.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.08
|
| Rate for Payer: Priority Health SBD |
$223.00
|
| Rate for Payer: UMR Bronson Commercial |
$155.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.48
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$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: PHP Commercial |
$1,684.81
|
| 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 Commercial |
$1,387.49
|
| Rate for Payer: Cofinity Commercial |
$1,704.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,387.49
|
| 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: Priority Health Cigna Priority Health |
$1,288.38
|
| 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
|
|
