|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$3,053.73
|
|
|
Service Code
|
NDC 00904679604
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,923.85 |
| Max. Negotiated Rate |
$2,748.36 |
| Rate for Payer: Aetna Commercial |
$2,595.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.92
|
| Rate for Payer: Cash Price |
$2,442.98
|
| Rate for Payer: Cofinity Advantage |
$2,137.61
|
| Rate for Payer: Cofinity Commercial |
$2,626.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.98
|
| Rate for Payer: Healthscope Commercial |
$2,748.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,595.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.30
|
| Rate for Payer: PHP Commercial |
$2,595.67
|
| Rate for Payer: Priority Health SBD |
$1,923.85
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$18,251.51
|
|
|
Service Code
|
NDC 00004003822
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,498.45 |
| Max. Negotiated Rate |
$16,426.36 |
| Rate for Payer: Aetna Commercial |
$15,513.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,863.48
|
| Rate for Payer: Cash Price |
$14,601.21
|
| Rate for Payer: Cofinity Advantage |
$12,776.06
|
| Rate for Payer: Cofinity Commercial |
$15,696.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,601.21
|
| Rate for Payer: Healthscope Commercial |
$16,426.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,513.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,688.63
|
| Rate for Payer: PHP Commercial |
$15,513.78
|
| Rate for Payer: Priority Health SBD |
$11,498.45
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
OP
|
$1,629.82
|
|
|
Service Code
|
NDC 68084096525
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$640.52 |
| Max. Negotiated Rate |
$1,466.84 |
| Rate for Payer: Aetna Commercial |
$1,385.35
|
| Rate for Payer: Aetna Medicare |
$814.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.38
|
| Rate for Payer: BCBS Complete |
$651.93
|
| Rate for Payer: Cash Price |
$1,303.86
|
| Rate for Payer: Cofinity Advantage |
$1,140.87
|
| Rate for Payer: Cofinity Commercial |
$1,401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.86
|
| Rate for Payer: Healthscope Commercial |
$1,466.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,303.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.37
|
| Rate for Payer: PHP Commercial |
$1,385.35
|
| Rate for Payer: Priority Health SBD |
$1,026.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,059.38
|
| Rate for Payer: UHC Core |
$849.14
|
| Rate for Payer: UHC Exchange |
$640.52
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$54.33
|
|
|
Service Code
|
NDC 68084096595
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.31
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Cofinity Advantage |
$38.03
|
| Rate for Payer: Cofinity Commercial |
$46.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.46
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.75
|
| Rate for Payer: PHP Commercial |
$46.18
|
| Rate for Payer: Priority Health SBD |
$34.23
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
OP
|
$54.33
|
|
|
Service Code
|
NDC 68084096595
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.31
|
| Rate for Payer: BCBS Complete |
$21.73
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Cofinity Advantage |
$38.03
|
| Rate for Payer: Cofinity Commercial |
$46.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.46
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.75
|
| Rate for Payer: PHP Commercial |
$46.18
|
| Rate for Payer: Priority Health SBD |
$34.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.31
|
| Rate for Payer: UHC Core |
$28.31
|
| Rate for Payer: UHC Exchange |
$21.35
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
OP
|
$18,251.51
|
|
|
Service Code
|
NDC 00004003822
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,172.84 |
| Max. Negotiated Rate |
$16,426.36 |
| Rate for Payer: Aetna Commercial |
$15,513.78
|
| Rate for Payer: Aetna Medicare |
$9,125.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,863.48
|
| Rate for Payer: BCBS Complete |
$7,300.60
|
| Rate for Payer: Cash Price |
$14,601.21
|
| Rate for Payer: Cofinity Advantage |
$12,776.06
|
| Rate for Payer: Cofinity Commercial |
$15,696.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,601.21
|
| Rate for Payer: Healthscope Commercial |
$16,426.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,601.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,513.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,688.63
|
| Rate for Payer: PHP Commercial |
$15,513.78
|
| Rate for Payer: Priority Health SBD |
$11,498.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,863.48
|
| Rate for Payer: UHC Core |
$9,509.04
|
| Rate for Payer: UHC Exchange |
$7,172.84
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$1,629.82
|
|
|
Service Code
|
NDC 68084096525
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,026.79 |
| Max. Negotiated Rate |
$1,466.84 |
| Rate for Payer: Aetna Commercial |
$1,385.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.38
|
| Rate for Payer: Cash Price |
$1,303.86
|
| Rate for Payer: Cofinity Advantage |
$1,140.87
|
| Rate for Payer: Cofinity Commercial |
$1,401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.86
|
| Rate for Payer: Healthscope Commercial |
$1,466.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.37
|
| Rate for Payer: PHP Commercial |
$1,385.35
|
| Rate for Payer: Priority Health SBD |
$1,026.79
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
OP
|
$3,053.73
|
|
|
Service Code
|
NDC 00904679604
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,200.12 |
| Max. Negotiated Rate |
$2,748.36 |
| Rate for Payer: Aetna Commercial |
$2,595.67
|
| Rate for Payer: Aetna Medicare |
$1,526.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.92
|
| Rate for Payer: BCBS Complete |
$1,221.49
|
| Rate for Payer: Cash Price |
$2,442.98
|
| Rate for Payer: Cofinity Advantage |
$2,137.61
|
| Rate for Payer: Cofinity Commercial |
$2,626.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.98
|
| Rate for Payer: Healthscope Commercial |
$2,748.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,442.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,595.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,290.30
|
| Rate for Payer: PHP Commercial |
$2,595.67
|
| Rate for Payer: Priority Health SBD |
$1,923.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,984.92
|
| Rate for Payer: UHC Core |
$1,590.99
|
| Rate for Payer: UHC Exchange |
$1,200.12
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.82
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Advantage |
$11.32
|
| Rate for Payer: Cofinity Advantage |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.36
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: Priority Health SBD |
$18.79
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna Medicare |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Advantage |
$11.32
|
| Rate for Payer: Cofinity Advantage |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.36
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 63739008610
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.94 |
| Max. Negotiated Rate |
$264.19 |
| 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 Advantage |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.16
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health SBD |
$184.94
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 69452015020
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.13 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health SBD |
$256.13
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 69452015020
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.77 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.26
|
| Rate for Payer: UHC Core |
$211.81
|
| Rate for Payer: UHC Exchange |
$159.77
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 63739008610
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$264.19 |
| 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 Advantage |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.16
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.81
|
| Rate for Payer: UHC Core |
$152.94
|
| Rate for Payer: UHC Exchange |
$115.37
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 00121135010
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 00121135000
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
|
OP
|
$23.37
|
|
|
Service Code
|
NDC 00121135010
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.19
|
| Rate for Payer: UHC Core |
$12.18
|
| Rate for Payer: UHC Exchange |
$9.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION
|
Facility
|
OP
|
$23.37
|
|
|
Service Code
|
NDC 00121135000
|
| Hospital Charge Code |
156035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.19
|
| Rate for Payer: UHC Core |
$12.18
|
| Rate for Payer: UHC Exchange |
$9.18
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 60687061211
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.55
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Exchange |
$1.54
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 60687061211
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Advantage |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health SBD |
$2.48
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$117.80
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Aetna Commercial |
$100.13
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.57
|
| Rate for Payer: BCBS Complete |
$47.12
|
| Rate for Payer: Cash Price |
$94.24
|
| Rate for Payer: Cofinity Advantage |
$82.46
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.24
|
| Rate for Payer: Healthscope Commercial |
$106.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.35
|
| Rate for Payer: PHP Commercial |
$100.13
|
| Rate for Payer: Priority Health SBD |
$74.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.57
|
| Rate for Payer: UHC Core |
$61.37
|
| Rate for Payer: UHC Exchange |
$46.30
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$361.67
|
|
|
Service Code
|
NDC 43547036709
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.85 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.09
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Advantage |
$253.17
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health SBD |
$227.85
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$117.80
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Aetna Commercial |
$100.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.57
|
| Rate for Payer: Cash Price |
$94.24
|
| Rate for Payer: Cofinity Advantage |
$82.46
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.24
|
| Rate for Payer: Healthscope Commercial |
$106.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.35
|
| Rate for Payer: PHP Commercial |
$100.13
|
| Rate for Payer: Priority Health SBD |
$74.21
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$361.67
|
|
|
Service Code
|
NDC 43547036709
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.14 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: Aetna Medicare |
$180.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.09
|
| Rate for Payer: BCBS Complete |
$144.67
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Advantage |
$253.17
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health SBD |
$227.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.09
|
| Rate for Payer: UHC Core |
$188.43
|
| Rate for Payer: UHC Exchange |
$142.14
|
|
|
VALSARTAN 80 MG TABLET
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 60687062311
|
| Hospital Charge Code |
31209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.36
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Advantage |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.88
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$2.69
|
| Rate for Payer: UHC Exchange |
$2.03
|
|
