Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION

Facility

$5,511.09

Service Code	HCPCS J3358
Hospital Charge Code	180872
Hospital Revenue Code	636
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$4,959.98
Rate for Payer: Aetna Commercial	$4,684.43
Rate for Payer: Aetna Medicare	$13.51
Rate for Payer: Aetna New Business (MI Preferred)	$3,582.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.24
Rate for Payer: Amish Plain Church Group Commercial	$16.24
Rate for Payer: BCBS Complete	$7.31
Rate for Payer: BCBS MAPPO	$12.99
Rate for Payer: BCN Medicare Advantage	$12.99
Rate for Payer: Cash Price	$4,408.87
Rate for Payer: Cash Price	$4,408.87
Rate for Payer: Cofinity Commercial	$4,739.54
Rate for Payer: Cofinity Commercial	$3,857.76
Rate for Payer: Cofinity Medicare Advantage	$3,857.76
Rate for Payer: Encore Health Key Benefits Commercial	$4,408.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.99
Rate for Payer: Healthscope Commercial	$4,959.98
Rate for Payer: Mclaren Medicaid	$6.96
Rate for Payer: Mclaren Medicare	$12.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.64
Rate for Payer: Meridian Medicaid	$7.31
Rate for Payer: MI Amish Medical Board Commercial	$14.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,684.43
Rate for Payer: PACE Medicare	$12.34
Rate for Payer: PACE SWMI	$12.99
Rate for Payer: PHP Commercial	$4,684.43
Rate for Payer: PHP Medicare Advantage	$12.99
Rate for Payer: Priority Health Choice Medicaid	$6.96
Rate for Payer: Priority Health Cigna Priority Health	$3,582.21
Rate for Payer: Priority Health Medicare	$12.99
Rate for Payer: Priority Health SBD	$3,471.99
Rate for Payer: Railroad Medicare Medicare	$12.99
Rate for Payer: UHC All Payor (Choice/PPO)	$36.57
Rate for Payer: UHC Dual Complete DSNP	$12.99
Rate for Payer: UHC Medicare Advantage	$12.99
Rate for Payer: UHCCP Medicaid	$7.31
Rate for Payer: VA VA	$12.99

USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION

Facility

$5,511.09

Service Code	HCPCS J3358
Hospital Charge Code	180872
Hospital Revenue Code	636
Min. Negotiated Rate	$3,471.99
Max. Negotiated Rate	$4,959.98
Rate for Payer: Aetna Commercial	$4,684.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,582.21
Rate for Payer: Cash Price	$4,408.87
Rate for Payer: Cofinity Commercial	$3,857.76
Rate for Payer: Cofinity Commercial	$4,739.54
Rate for Payer: Cofinity Medicare Advantage	$3,857.76
Rate for Payer: Encore Health Key Benefits Commercial	$4,408.87
Rate for Payer: Healthscope Commercial	$4,959.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,684.43
Rate for Payer: PHP Commercial	$4,684.43
Rate for Payer: Priority Health Cigna Priority Health	$3,582.21
Rate for Payer: Priority Health SBD	$3,471.99

USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$36,949.51

Service Code	HCPCS J3357
Hospital Charge Code	119468
Hospital Revenue Code	636
Min. Negotiated Rate	$80.08
Max. Negotiated Rate	$33,254.56
Rate for Payer: Aetna Commercial	$31,407.08
Rate for Payer: Aetna Medicare	$155.38
Rate for Payer: Aetna New Business (MI Preferred)	$24,017.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$186.75
Rate for Payer: Amish Plain Church Group Commercial	$186.75
Rate for Payer: BCBS Complete	$84.08
Rate for Payer: BCBS MAPPO	$149.40
Rate for Payer: BCN Medicare Advantage	$149.40
Rate for Payer: Cash Price	$29,559.61
Rate for Payer: Cash Price	$29,559.61
Rate for Payer: Cofinity Commercial	$31,776.58
Rate for Payer: Cofinity Commercial	$25,864.66
Rate for Payer: Cofinity Medicare Advantage	$25,864.66
Rate for Payer: Encore Health Key Benefits Commercial	$29,559.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$149.40
Rate for Payer: Healthscope Commercial	$33,254.56
Rate for Payer: Mclaren Medicaid	$80.08
Rate for Payer: Mclaren Medicare	$149.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$156.87
Rate for Payer: Meridian Medicaid	$84.08
Rate for Payer: MI Amish Medical Board Commercial	$171.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31,407.08
Rate for Payer: PACE Medicare	$141.93
Rate for Payer: PACE SWMI	$149.40
Rate for Payer: PHP Commercial	$31,407.08
Rate for Payer: PHP Medicare Advantage	$149.40
Rate for Payer: Priority Health Choice Medicaid	$80.08
Rate for Payer: Priority Health Cigna Priority Health	$24,017.18
Rate for Payer: Priority Health Medicare	$149.40
Rate for Payer: Priority Health SBD	$23,278.19
Rate for Payer: Railroad Medicare Medicare	$149.40
Rate for Payer: UHC All Payor (Choice/PPO)	$420.55
Rate for Payer: UHC Dual Complete DSNP	$149.40
Rate for Payer: UHC Medicare Advantage	$149.40
Rate for Payer: UHCCP Medicaid	$84.11
Rate for Payer: VA VA	$149.40

USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$36,949.51

Service Code	HCPCS J3357
Hospital Charge Code	119468
Hospital Revenue Code	636
Min. Negotiated Rate	$23,278.19
Max. Negotiated Rate	$33,254.56
Rate for Payer: Aetna Commercial	$31,407.08
Rate for Payer: Aetna New Business (MI Preferred)	$24,017.18
Rate for Payer: Cash Price	$29,559.61
Rate for Payer: Cofinity Commercial	$25,864.66
Rate for Payer: Cofinity Commercial	$31,776.58
Rate for Payer: Cofinity Medicare Advantage	$25,864.66
Rate for Payer: Encore Health Key Benefits Commercial	$29,559.61
Rate for Payer: Healthscope Commercial	$33,254.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31,407.08
Rate for Payer: PHP Commercial	$31,407.08
Rate for Payer: Priority Health Cigna Priority Health	$24,017.18
Rate for Payer: Priority Health SBD	$23,278.19

USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE

Facility

$73,898.95

Service Code	HCPCS J3357
Hospital Charge Code	119469
Hospital Revenue Code	636
Min. Negotiated Rate	$80.08
Max. Negotiated Rate	$66,509.05
Rate for Payer: Aetna Commercial	$62,814.11
Rate for Payer: Aetna Medicare	$155.38
Rate for Payer: Aetna New Business (MI Preferred)	$48,034.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$186.75
Rate for Payer: Amish Plain Church Group Commercial	$186.75
Rate for Payer: BCBS Complete	$84.08
Rate for Payer: BCBS MAPPO	$149.40
Rate for Payer: BCN Medicare Advantage	$149.40
Rate for Payer: Cash Price	$59,119.16
Rate for Payer: Cash Price	$59,119.16
Rate for Payer: Cofinity Commercial	$63,553.10
Rate for Payer: Cofinity Commercial	$51,729.26
Rate for Payer: Cofinity Medicare Advantage	$51,729.26
Rate for Payer: Encore Health Key Benefits Commercial	$59,119.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$149.40
Rate for Payer: Healthscope Commercial	$66,509.05
Rate for Payer: Mclaren Medicaid	$80.08
Rate for Payer: Mclaren Medicare	$149.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$156.87
Rate for Payer: Meridian Medicaid	$84.08
Rate for Payer: MI Amish Medical Board Commercial	$171.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62,814.11
Rate for Payer: PACE Medicare	$141.93
Rate for Payer: PACE SWMI	$149.40
Rate for Payer: PHP Commercial	$62,814.11
Rate for Payer: PHP Medicare Advantage	$149.40
Rate for Payer: Priority Health Choice Medicaid	$80.08
Rate for Payer: Priority Health Cigna Priority Health	$48,034.32
Rate for Payer: Priority Health Medicare	$149.40
Rate for Payer: Priority Health SBD	$46,556.34
Rate for Payer: Railroad Medicare Medicare	$149.40
Rate for Payer: UHC All Payor (Choice/PPO)	$420.55
Rate for Payer: UHC Dual Complete DSNP	$149.40
Rate for Payer: UHC Medicare Advantage	$149.40
Rate for Payer: UHCCP Medicaid	$84.11
Rate for Payer: VA VA	$149.40

USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE

Facility

$73,898.95

Service Code	HCPCS J3357
Hospital Charge Code	119469
Hospital Revenue Code	636
Min. Negotiated Rate	$46,556.34
Max. Negotiated Rate	$66,509.05
Rate for Payer: Aetna Commercial	$62,814.11
Rate for Payer: Aetna New Business (MI Preferred)	$48,034.32
Rate for Payer: Cash Price	$59,119.16
Rate for Payer: Cofinity Commercial	$51,729.26
Rate for Payer: Cofinity Commercial	$63,553.10
Rate for Payer: Cofinity Medicare Advantage	$51,729.26
Rate for Payer: Encore Health Key Benefits Commercial	$59,119.16
Rate for Payer: Healthscope Commercial	$66,509.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62,814.11
Rate for Payer: PHP Commercial	$62,814.11
Rate for Payer: Priority Health Cigna Priority Health	$48,034.32
Rate for Payer: Priority Health SBD	$46,556.34

VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$13,552.11

Service Code	CPT 58260
Hospital Revenue Code	360
Min. Negotiated Rate	$2,580.53
Max. Negotiated Rate	$13,552.11
Rate for Payer: Aetna Medicare	$5,007.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,018.02
Rate for Payer: Amish Plain Church Group Commercial	$6,018.02
Rate for Payer: BCBS Complete	$2,709.56
Rate for Payer: BCBS MAPPO	$4,814.42
Rate for Payer: BCN Medicare Advantage	$4,814.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,814.42
Rate for Payer: Mclaren Medicaid	$2,580.53
Rate for Payer: Mclaren Medicare	$4,814.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,055.14
Rate for Payer: Meridian Medicaid	$2,709.56
Rate for Payer: MI Amish Medical Board Commercial	$5,536.58
Rate for Payer: PACE Medicare	$4,573.70
Rate for Payer: PACE SWMI	$4,814.42
Rate for Payer: PHP Medicare Advantage	$4,814.42
Rate for Payer: Priority Health Choice Medicaid	$2,580.53
Rate for Payer: Priority Health Medicare	$4,814.42
Rate for Payer: Railroad Medicare Medicare	$4,814.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13,552.11
Rate for Payer: UHC Dual Complete DSNP	$4,814.42
Rate for Payer: UHC Medicare Advantage	$4,814.42
Rate for Payer: UHCCP Medicaid	$2,710.52
Rate for Payer: VA VA	$4,814.42

VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)

Facility

$13,552.11

Service Code	CPT 58262
Hospital Revenue Code	360
Min. Negotiated Rate	$2,580.53
Max. Negotiated Rate	$13,552.11
Rate for Payer: Aetna Medicare	$5,007.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,018.02
Rate for Payer: Amish Plain Church Group Commercial	$6,018.02
Rate for Payer: BCBS Complete	$2,709.56
Rate for Payer: BCBS MAPPO	$4,814.42
Rate for Payer: BCN Medicare Advantage	$4,814.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,814.42
Rate for Payer: Mclaren Medicaid	$2,580.53
Rate for Payer: Mclaren Medicare	$4,814.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,055.14
Rate for Payer: Meridian Medicaid	$2,709.56
Rate for Payer: MI Amish Medical Board Commercial	$5,536.58
Rate for Payer: PACE Medicare	$4,573.70
Rate for Payer: PACE SWMI	$4,814.42
Rate for Payer: PHP Medicare Advantage	$4,814.42
Rate for Payer: Priority Health Choice Medicaid	$2,580.53
Rate for Payer: Priority Health Medicare	$4,814.42
Rate for Payer: Railroad Medicare Medicare	$4,814.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13,552.11
Rate for Payer: UHC Dual Complete DSNP	$4,814.42
Rate for Payer: UHC Medicare Advantage	$4,814.42
Rate for Payer: UHCCP Medicaid	$2,710.52
Rate for Payer: VA VA	$4,814.42

VALACYCLOVIR 500 MG TABLET

Facility

$494.88

Service Code	NDC 00904656561
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$197.95
Max. Negotiated Rate	$445.39
Rate for Payer: Aetna Commercial	$420.65
Rate for Payer: Aetna Medicare	$247.44
Rate for Payer: Aetna New Business (MI Preferred)	$321.67
Rate for Payer: BCBS Complete	$197.95
Rate for Payer: Cash Price	$395.90
Rate for Payer: Cofinity Commercial	$346.42
Rate for Payer: Cofinity Commercial	$425.60
Rate for Payer: Cofinity Medicare Advantage	$346.42
Rate for Payer: Encore Health Key Benefits Commercial	$395.90
Rate for Payer: Healthscope Commercial	$445.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.65
Rate for Payer: PHP Commercial	$420.65
Rate for Payer: Priority Health Cigna Priority Health	$321.67
Rate for Payer: Priority Health SBD	$311.77

VALACYCLOVIR 500 MG TABLET

Facility

$494.88

Service Code	NDC 00904656561
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$311.77
Max. Negotiated Rate	$445.39
Rate for Payer: Aetna Commercial	$420.65
Rate for Payer: Aetna New Business (MI Preferred)	$321.67
Rate for Payer: Cash Price	$395.90
Rate for Payer: Cofinity Commercial	$346.42
Rate for Payer: Cofinity Commercial	$425.60
Rate for Payer: Cofinity Medicare Advantage	$346.42
Rate for Payer: Encore Health Key Benefits Commercial	$395.90
Rate for Payer: Healthscope Commercial	$445.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.65
Rate for Payer: PHP Commercial	$420.65
Rate for Payer: Priority Health Cigna Priority Health	$321.67
Rate for Payer: Priority Health SBD	$311.77

VALACYCLOVIR 500 MG TABLET

Facility

$316.91

Service Code	NDC 51079009303
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$126.76
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna Medicare	$158.46
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: BCBS Complete	$126.76
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Cofinity Medicare Advantage	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health Cigna Priority Health	$205.99
Rate for Payer: Priority Health SBD	$199.65

VALACYCLOVIR 500 MG TABLET

Facility

$316.91

Service Code	NDC 51079009303
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$199.65
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Cofinity Medicare Advantage	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health Cigna Priority Health	$205.99
Rate for Payer: Priority Health SBD	$199.65

VALGANCICLOVIR 450 MG TABLET

Facility

$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 Commercial	$12,776.06
Rate for Payer: Cofinity Commercial	$15,696.30
Rate for Payer: Cofinity Medicare Advantage	$12,776.06
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: PHP Commercial	$15,513.78
Rate for Payer: Priority Health Cigna Priority Health	$11,863.48
Rate for Payer: Priority Health SBD	$11,498.45

VALGANCICLOVIR 450 MG TABLET

Facility

$54.85

Service Code	NDC 68084096595
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$49.37
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare	$27.43
Rate for Payer: Aetna New Business (MI Preferred)	$35.65
Rate for Payer: BCBS Complete	$21.94
Rate for Payer: Cash Price	$43.88
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Commercial	$47.17
Rate for Payer: Cofinity Medicare Advantage	$38.40
Rate for Payer: Encore Health Key Benefits Commercial	$43.88
Rate for Payer: Healthscope Commercial	$49.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.62
Rate for Payer: PHP Commercial	$46.62
Rate for Payer: Priority Health Cigna Priority Health	$35.65
Rate for Payer: Priority Health SBD	$34.56

VALGANCICLOVIR 450 MG TABLET

Facility

$1,645.47

Service Code	NDC 68084096525
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$658.19
Max. Negotiated Rate	$1,480.92
Rate for Payer: Aetna Commercial	$1,398.65
Rate for Payer: Aetna Medicare	$822.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,069.56
Rate for Payer: BCBS Complete	$658.19
Rate for Payer: Cash Price	$1,316.38
Rate for Payer: Cofinity Commercial	$1,151.83
Rate for Payer: Cofinity Commercial	$1,415.10
Rate for Payer: Cofinity Medicare Advantage	$1,151.83
Rate for Payer: Encore Health Key Benefits Commercial	$1,316.38
Rate for Payer: Healthscope Commercial	$1,480.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,398.65
Rate for Payer: PHP Commercial	$1,398.65
Rate for Payer: Priority Health Cigna Priority Health	$1,069.56
Rate for Payer: Priority Health SBD	$1,036.65

VALGANCICLOVIR 450 MG TABLET

Facility

$1,645.47

Service Code	NDC 68084096525
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$1,036.65
Max. Negotiated Rate	$1,480.92
Rate for Payer: Aetna Commercial	$1,398.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,069.56
Rate for Payer: Cash Price	$1,316.38
Rate for Payer: Cofinity Commercial	$1,151.83
Rate for Payer: Cofinity Commercial	$1,415.10
Rate for Payer: Cofinity Medicare Advantage	$1,151.83
Rate for Payer: Encore Health Key Benefits Commercial	$1,316.38
Rate for Payer: Healthscope Commercial	$1,480.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,398.65
Rate for Payer: PHP Commercial	$1,398.65
Rate for Payer: Priority Health Cigna Priority Health	$1,069.56
Rate for Payer: Priority Health SBD	$1,036.65

VALGANCICLOVIR 450 MG TABLET

Facility

$3,184.93

Service Code	NDC 00904679604
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$1,273.97
Max. Negotiated Rate	$2,866.44
Rate for Payer: Aetna Commercial	$2,707.19
Rate for Payer: Aetna Medicare	$1,592.46
Rate for Payer: Aetna New Business (MI Preferred)	$2,070.20
Rate for Payer: BCBS Complete	$1,273.97
Rate for Payer: Cash Price	$2,547.94
Rate for Payer: Cofinity Commercial	$2,229.45
Rate for Payer: Cofinity Commercial	$2,739.04
Rate for Payer: Cofinity Medicare Advantage	$2,229.45
Rate for Payer: Encore Health Key Benefits Commercial	$2,547.94
Rate for Payer: Healthscope Commercial	$2,866.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,707.19
Rate for Payer: PHP Commercial	$2,707.19
Rate for Payer: Priority Health Cigna Priority Health	$2,070.20
Rate for Payer: Priority Health SBD	$2,006.51

VALGANCICLOVIR 450 MG TABLET

Facility

$54.85

Service Code	NDC 68084096595
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$49.37
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna New Business (MI Preferred)	$35.65
Rate for Payer: Cash Price	$43.88
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Commercial	$47.17
Rate for Payer: Cofinity Medicare Advantage	$38.40
Rate for Payer: Encore Health Key Benefits Commercial	$43.88
Rate for Payer: Healthscope Commercial	$49.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.62
Rate for Payer: PHP Commercial	$46.62
Rate for Payer: Priority Health Cigna Priority Health	$35.65
Rate for Payer: Priority Health SBD	$34.56

VALGANCICLOVIR 450 MG TABLET

Facility

$3,184.93

Service Code	NDC 00904679604
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$2,006.51
Max. Negotiated Rate	$2,866.44
Rate for Payer: Aetna Commercial	$2,707.19
Rate for Payer: Aetna New Business (MI Preferred)	$2,070.20
Rate for Payer: Cash Price	$2,547.94
Rate for Payer: Cofinity Commercial	$2,229.45
Rate for Payer: Cofinity Commercial	$2,739.04
Rate for Payer: Cofinity Medicare Advantage	$2,229.45
Rate for Payer: Encore Health Key Benefits Commercial	$2,547.94
Rate for Payer: Healthscope Commercial	$2,866.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,707.19
Rate for Payer: PHP Commercial	$2,707.19
Rate for Payer: Priority Health Cigna Priority Health	$2,070.20
Rate for Payer: Priority Health SBD	$2,006.51

VALGANCICLOVIR 450 MG TABLET

Facility

$18,251.51

Service Code	NDC 00004003822
Hospital Charge Code	30148
Hospital Revenue Code	637
Min. Negotiated Rate	$7,300.60
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 Commercial	$12,776.06
Rate for Payer: Cofinity Commercial	$15,696.30
Rate for Payer: Cofinity Medicare Advantage	$12,776.06
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: PHP Commercial	$15,513.78
Rate for Payer: Priority Health Cigna Priority Health	$11,863.48
Rate for Payer: Priority Health SBD	$11,498.45

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.17

Service Code	NDC 00143978510
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$14.55
Rate for Payer: Aetna Commercial	$13.74
Rate for Payer: Aetna New Business (MI Preferred)	$10.51
Rate for Payer: Cash Price	$12.94
Rate for Payer: Cofinity Commercial	$11.32
Rate for Payer: Cofinity Commercial	$13.91
Rate for Payer: Cofinity Medicare Advantage	$11.32
Rate for Payer: Encore Health Key Benefits Commercial	$12.94
Rate for Payer: Healthscope Commercial	$14.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.74
Rate for Payer: PHP Commercial	$13.74
Rate for Payer: Priority Health Cigna Priority Health	$10.51
Rate for Payer: Priority Health SBD	$10.19

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.17

Service Code	NDC 00143978510
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$14.55
Rate for Payer: Aetna Commercial	$13.74
Rate for Payer: Aetna Medicare	$8.09
Rate for Payer: Aetna New Business (MI Preferred)	$10.51
Rate for Payer: BCBS Complete	$6.47
Rate for Payer: Cash Price	$12.94
Rate for Payer: Cofinity Commercial	$13.91
Rate for Payer: Cofinity Commercial	$11.32
Rate for Payer: Cofinity Medicare Advantage	$11.32
Rate for Payer: Encore Health Key Benefits Commercial	$12.94
Rate for Payer: Healthscope Commercial	$14.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.74
Rate for Payer: PHP Commercial	$13.74
Rate for Payer: Priority Health Cigna Priority Health	$10.51
Rate for Payer: Priority Health SBD	$10.19

VALPROIC ACID 250 MG CAPSULE

Facility

$359.55

Service Code	NDC 69452015020
Hospital Charge Code	8429
Hospital Revenue Code	637
Min. Negotiated Rate	$143.82
Max. Negotiated Rate	$323.60
Rate for Payer: Aetna Commercial	$305.62
Rate for Payer: Aetna Medicare	$179.78
Rate for Payer: Aetna New Business (MI Preferred)	$233.71
Rate for Payer: BCBS Complete	$143.82
Rate for Payer: Cash Price	$287.64
Rate for Payer: Cofinity Commercial	$251.69
Rate for Payer: Cofinity Commercial	$309.21
Rate for Payer: Cofinity Medicare Advantage	$251.69
Rate for Payer: Encore Health Key Benefits Commercial	$287.64
Rate for Payer: Healthscope Commercial	$323.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$305.62
Rate for Payer: PHP Commercial	$305.62
Rate for Payer: Priority Health Cigna Priority Health	$233.71
Rate for Payer: Priority Health SBD	$226.52

VALPROIC ACID 250 MG CAPSULE

Facility

$293.55

Service Code	NDC 63739008610
Hospital Charge Code	8429
Hospital Revenue Code	637
Min. Negotiated Rate	$117.42
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 Commercial	$205.49
Rate for Payer: Cofinity Commercial	$252.45
Rate for Payer: Cofinity Medicare Advantage	$205.49
Rate for Payer: Encore Health Key Benefits Commercial	$234.84
Rate for Payer: Healthscope Commercial	$264.19
Rate for Payer: 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

VALPROIC ACID 250 MG CAPSULE

Facility

$359.55

Service Code	NDC 69452015020
Hospital Charge Code	8429
Hospital Revenue Code	637
Min. Negotiated Rate	$226.52
Max. Negotiated Rate	$323.60
Rate for Payer: Aetna Commercial	$305.62
Rate for Payer: Aetna New Business (MI Preferred)	$233.71
Rate for Payer: Cash Price	$287.64
Rate for Payer: Cofinity Commercial	$251.69
Rate for Payer: Cofinity Commercial	$309.21
Rate for Payer: Cofinity Medicare Advantage	$251.69
Rate for Payer: Encore Health Key Benefits Commercial	$287.64
Rate for Payer: Healthscope Commercial	$323.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$305.62
Rate for Payer: PHP Commercial	$305.62
Rate for Payer: Priority Health Cigna Priority Health	$233.71
Rate for Payer: Priority Health SBD	$226.52

Know your out-of-pocket cost for care.

All Charges