Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$22.56

Service Code	NDC 68094070162
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$20.30
Rate for Payer: Aetna Commercial	$19.18
Rate for Payer: Aetna New Business (MI Preferred)	$14.66
Rate for Payer: Cash Price	$18.05
Rate for Payer: Cofinity Commercial	$15.79
Rate for Payer: Cofinity Commercial	$19.40
Rate for Payer: Cofinity Medicare Advantage	$15.79
Rate for Payer: Encore Health Key Benefits Commercial	$18.05
Rate for Payer: Healthscope Commercial	$20.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.18
Rate for Payer: PHP Commercial	$19.18
Rate for Payer: Priority Health Cigna Priority Health	$14.66
Rate for Payer: Priority Health SBD	$14.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026248
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare	$9.16
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: BCBS Complete	$7.33
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$17.63

Service Code	NDC 68094070161
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$15.87
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna Medicare	$8.82
Rate for Payer: Aetna New Business (MI Preferred)	$11.46
Rate for Payer: BCBS Complete	$7.05
Rate for Payer: Cash Price	$14.10
Rate for Payer: Cofinity Commercial	$12.34
Rate for Payer: Cofinity Commercial	$15.16
Rate for Payer: Cofinity Medicare Advantage	$12.34
Rate for Payer: Encore Health Key Benefits Commercial	$14.10
Rate for Payer: Healthscope Commercial	$15.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.99
Rate for Payer: PHP Commercial	$14.99
Rate for Payer: Priority Health Cigna Priority Health	$11.46
Rate for Payer: Priority Health SBD	$11.11

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026242
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026248
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026256
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026242
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare	$9.16
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: BCBS Complete	$7.33
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$19.38

Service Code	NDC 00121135000
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$17.44
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna New Business (MI Preferred)	$12.60
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cofinity Commercial	$13.57
Rate for Payer: Cofinity Commercial	$16.67
Rate for Payer: Cofinity Medicare Advantage	$13.57
Rate for Payer: Encore Health Key Benefits Commercial	$15.50
Rate for Payer: Healthscope Commercial	$17.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.47
Rate for Payer: PHP Commercial	$16.47
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health SBD	$12.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$19.38

Service Code	NDC 00121135010
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$17.44
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna New Business (MI Preferred)	$12.60
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cofinity Commercial	$13.57
Rate for Payer: Cofinity Commercial	$16.67
Rate for Payer: Cofinity Medicare Advantage	$13.57
Rate for Payer: Encore Health Key Benefits Commercial	$15.50
Rate for Payer: Healthscope Commercial	$17.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.47
Rate for Payer: PHP Commercial	$16.47
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health SBD	$12.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$18.33

Service Code	NDC 60687026256
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare	$9.16
Rate for Payer: Aetna New Business (MI Preferred)	$11.91
Rate for Payer: BCBS Complete	$7.33
Rate for Payer: Cash Price	$14.66
Rate for Payer: Cofinity Commercial	$12.83
Rate for Payer: Cofinity Commercial	$15.76
Rate for Payer: Cofinity Medicare Advantage	$12.83
Rate for Payer: Encore Health Key Benefits Commercial	$14.66
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.58
Rate for Payer: PHP Commercial	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.91
Rate for Payer: Priority Health SBD	$11.55

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$19.38

Service Code	NDC 00121135010
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$17.44
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna Medicare	$9.69
Rate for Payer: Aetna New Business (MI Preferred)	$12.60
Rate for Payer: BCBS Complete	$7.75
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cofinity Commercial	$13.57
Rate for Payer: Cofinity Commercial	$16.67
Rate for Payer: Cofinity Medicare Advantage	$13.57
Rate for Payer: Encore Health Key Benefits Commercial	$15.50
Rate for Payer: Healthscope Commercial	$17.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.47
Rate for Payer: PHP Commercial	$16.47
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health SBD	$12.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$17.63

Service Code	NDC 68094070159
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$15.87
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna New Business (MI Preferred)	$11.46
Rate for Payer: Cash Price	$14.10
Rate for Payer: Cofinity Commercial	$12.34
Rate for Payer: Cofinity Commercial	$15.16
Rate for Payer: Cofinity Medicare Advantage	$12.34
Rate for Payer: Encore Health Key Benefits Commercial	$14.10
Rate for Payer: Healthscope Commercial	$15.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.99
Rate for Payer: PHP Commercial	$14.99
Rate for Payer: Priority Health Cigna Priority Health	$11.46
Rate for Payer: Priority Health SBD	$11.11

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$17.63

Service Code	NDC 68094070159
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$15.87
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna Medicare	$8.82
Rate for Payer: Aetna New Business (MI Preferred)	$11.46
Rate for Payer: BCBS Complete	$7.05
Rate for Payer: Cash Price	$14.10
Rate for Payer: Cofinity Commercial	$12.34
Rate for Payer: Cofinity Commercial	$15.16
Rate for Payer: Cofinity Medicare Advantage	$12.34
Rate for Payer: Encore Health Key Benefits Commercial	$14.10
Rate for Payer: Healthscope Commercial	$15.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.99
Rate for Payer: PHP Commercial	$14.99
Rate for Payer: Priority Health Cigna Priority Health	$11.46
Rate for Payer: Priority Health SBD	$11.11

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$22.56

Service Code	NDC 68094070162
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$20.30
Rate for Payer: Aetna Commercial	$19.18
Rate for Payer: Aetna Medicare	$11.28
Rate for Payer: Aetna New Business (MI Preferred)	$14.66
Rate for Payer: BCBS Complete	$9.02
Rate for Payer: Cash Price	$18.05
Rate for Payer: Cofinity Commercial	$15.79
Rate for Payer: Cofinity Commercial	$19.40
Rate for Payer: Cofinity Medicare Advantage	$15.79
Rate for Payer: Encore Health Key Benefits Commercial	$18.05
Rate for Payer: Healthscope Commercial	$20.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.18
Rate for Payer: PHP Commercial	$19.18
Rate for Payer: Priority Health Cigna Priority Health	$14.66
Rate for Payer: Priority Health SBD	$14.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$19.38

Service Code	NDC 00121135000
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$17.44
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna Medicare	$9.69
Rate for Payer: Aetna New Business (MI Preferred)	$12.60
Rate for Payer: BCBS Complete	$7.75
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cofinity Commercial	$13.57
Rate for Payer: Cofinity Commercial	$16.67
Rate for Payer: Cofinity Medicare Advantage	$13.57
Rate for Payer: Encore Health Key Benefits Commercial	$15.50
Rate for Payer: Healthscope Commercial	$17.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.47
Rate for Payer: PHP Commercial	$16.47
Rate for Payer: Priority Health Cigna Priority Health	$12.60
Rate for Payer: Priority Health SBD	$12.21

VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION

Facility

$17.63

Service Code	NDC 68094070161
Hospital Charge Code	156035
Hospital Revenue Code	637
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$15.87
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna New Business (MI Preferred)	$11.46
Rate for Payer: Cash Price	$14.10
Rate for Payer: Cofinity Commercial	$12.34
Rate for Payer: Cofinity Commercial	$15.16
Rate for Payer: Cofinity Medicare Advantage	$12.34
Rate for Payer: Encore Health Key Benefits Commercial	$14.10
Rate for Payer: Healthscope Commercial	$15.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.99
Rate for Payer: PHP Commercial	$14.99
Rate for Payer: Priority Health Cigna Priority Health	$11.46
Rate for Payer: Priority Health SBD	$11.11

VALSARTAN 40 MG TABLET

Facility

$3.72

Service Code	NDC 60687061211
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

VALSARTAN 40 MG TABLET

Facility

$3.72

Service Code	NDC 60687061211
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna Medicare	$1.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: BCBS Complete	$1.49
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

VALSARTAN 40 MG TABLET

Facility

$353.21

Service Code	NDC 43547036709
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$317.89
Rate for Payer: Aetna Commercial	$300.23
Rate for Payer: Aetna Medicare	$176.60
Rate for Payer: Aetna New Business (MI Preferred)	$229.59
Rate for Payer: BCBS Complete	$141.28
Rate for Payer: Cash Price	$282.57
Rate for Payer: Cofinity Commercial	$247.25
Rate for Payer: Cofinity Commercial	$303.76
Rate for Payer: Cofinity Medicare Advantage	$247.25
Rate for Payer: Encore Health Key Benefits Commercial	$282.57
Rate for Payer: Healthscope Commercial	$317.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$300.23
Rate for Payer: PHP Commercial	$300.23
Rate for Payer: Priority Health Cigna Priority Health	$229.59
Rate for Payer: Priority Health SBD	$222.52

VALSARTAN 40 MG TABLET

Facility

$111.46

Service Code	NDC 60687061221
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$70.22
Max. Negotiated Rate	$100.31
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: Aetna New Business (MI Preferred)	$72.45
Rate for Payer: Cash Price	$89.17
Rate for Payer: Cofinity Commercial	$78.02
Rate for Payer: Cofinity Commercial	$95.86
Rate for Payer: Cofinity Medicare Advantage	$78.02
Rate for Payer: Encore Health Key Benefits Commercial	$89.17
Rate for Payer: Healthscope Commercial	$100.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.74
Rate for Payer: PHP Commercial	$94.74
Rate for Payer: Priority Health Cigna Priority Health	$72.45
Rate for Payer: Priority Health SBD	$70.22

VALSARTAN 40 MG TABLET

Facility

$111.46

Service Code	NDC 60687061221
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$44.58
Max. Negotiated Rate	$100.31
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: Aetna Medicare	$55.73
Rate for Payer: Aetna New Business (MI Preferred)	$72.45
Rate for Payer: BCBS Complete	$44.58
Rate for Payer: Cash Price	$89.17
Rate for Payer: Cofinity Commercial	$78.02
Rate for Payer: Cofinity Commercial	$95.86
Rate for Payer: Cofinity Medicare Advantage	$78.02
Rate for Payer: Encore Health Key Benefits Commercial	$89.17
Rate for Payer: Healthscope Commercial	$100.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.74
Rate for Payer: PHP Commercial	$94.74
Rate for Payer: Priority Health Cigna Priority Health	$72.45
Rate for Payer: Priority Health SBD	$70.22

VALSARTAN 40 MG TABLET

Facility

$353.21

Service Code	NDC 43547036709
Hospital Charge Code	33541
Hospital Revenue Code	637
Min. Negotiated Rate	$222.52
Max. Negotiated Rate	$317.89
Rate for Payer: Aetna Commercial	$300.23
Rate for Payer: Aetna New Business (MI Preferred)	$229.59
Rate for Payer: Cash Price	$282.57
Rate for Payer: Cofinity Commercial	$247.25
Rate for Payer: Cofinity Commercial	$303.76
Rate for Payer: Cofinity Medicare Advantage	$247.25
Rate for Payer: Encore Health Key Benefits Commercial	$282.57
Rate for Payer: Healthscope Commercial	$317.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$300.23
Rate for Payer: PHP Commercial	$300.23
Rate for Payer: Priority Health Cigna Priority Health	$229.59
Rate for Payer: Priority Health SBD	$222.52

VALSARTAN 80 MG TABLET

Facility

$265.05

Service Code	NDC 00378581377
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$238.54
Rate for Payer: Aetna Commercial	$225.29
Rate for Payer: Aetna Medicare	$132.52
Rate for Payer: Aetna New Business (MI Preferred)	$172.28
Rate for Payer: BCBS Complete	$106.02
Rate for Payer: Cash Price	$212.04
Rate for Payer: Cofinity Commercial	$185.54
Rate for Payer: Cofinity Commercial	$227.94
Rate for Payer: Cofinity Medicare Advantage	$185.54
Rate for Payer: Encore Health Key Benefits Commercial	$212.04
Rate for Payer: Healthscope Commercial	$238.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.29
Rate for Payer: PHP Commercial	$225.29
Rate for Payer: Priority Health Cigna Priority Health	$172.28
Rate for Payer: Priority Health SBD	$166.98

VALSARTAN 80 MG TABLET

Facility

$2,862.81

Service Code	NDC 00078035834
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$1,803.57
Max. Negotiated Rate	$2,576.53
Rate for Payer: Aetna Commercial	$2,433.39
Rate for Payer: Aetna New Business (MI Preferred)	$1,860.83
Rate for Payer: Cash Price	$2,290.25
Rate for Payer: Cofinity Commercial	$2,003.97
Rate for Payer: Cofinity Commercial	$2,462.02
Rate for Payer: Cofinity Medicare Advantage	$2,003.97
Rate for Payer: Encore Health Key Benefits Commercial	$2,290.25
Rate for Payer: Healthscope Commercial	$2,576.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,433.39
Rate for Payer: PHP Commercial	$2,433.39
Rate for Payer: Priority Health Cigna Priority Health	$1,860.83
Rate for Payer: Priority Health SBD	$1,803.57

VALSARTAN 80 MG TABLET

Facility

$2,862.81

Service Code	NDC 00078035834
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$1,145.12
Max. Negotiated Rate	$2,576.53
Rate for Payer: Aetna Commercial	$2,433.39
Rate for Payer: Aetna Medicare	$1,431.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,860.83
Rate for Payer: BCBS Complete	$1,145.12
Rate for Payer: Cash Price	$2,290.25
Rate for Payer: Cofinity Commercial	$2,003.97
Rate for Payer: Cofinity Commercial	$2,462.02
Rate for Payer: Cofinity Medicare Advantage	$2,003.97
Rate for Payer: Encore Health Key Benefits Commercial	$2,290.25
Rate for Payer: Healthscope Commercial	$2,576.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,433.39
Rate for Payer: PHP Commercial	$2,433.39
Rate for Payer: Priority Health Cigna Priority Health	$1,860.83
Rate for Payer: Priority Health SBD	$1,803.57

Know your out-of-pocket cost for care.

All Charges