|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 57237004701
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$42.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCN Commercial |
$126.07
|
| Rate for Payer: BCN Medicare Advantage |
$40.54
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.54
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: PACE Senior Care Partners |
$38.51
|
| Rate for Payer: PACE SWMI |
$40.54
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: PHP Medicare Advantage |
$40.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.40
|
| Rate for Payer: Priority Health HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Medicare |
$40.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.64
|
| Rate for Payer: Railroad Medicare Medicare |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.54
|
| Rate for Payer: UHC Exchange |
$40.54
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: VA VA |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$276.24
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 68084077611
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.17
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.89
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.94
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 68084077611
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 68084077601
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.74 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$97.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.77
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: BCBS MAPPO |
$93.41
|
| Rate for Payer: BCBS Trust/PPO |
$307.18
|
| Rate for Payer: BCN Commercial |
$290.51
|
| Rate for Payer: BCN Medicare Advantage |
$93.41
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.41
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: PACE Senior Care Partners |
$88.74
|
| Rate for Payer: PACE SWMI |
$93.41
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: PHP Medicare Advantage |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health HMO/PPO |
$325.08
|
| Rate for Payer: Priority Health Medicare |
$94.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.35
|
| Rate for Payer: Railroad Medicare Medicare |
$93.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.81
|
| Rate for Payer: UHC Core |
$312.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.41
|
| Rate for Payer: UHC Exchange |
$93.41
|
| Rate for Payer: UHC Medicare Advantage |
$93.41
|
| Rate for Payer: VA VA |
$93.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$87.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.75
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$263.11
|
| Rate for Payer: BCN Medicare Advantage |
$84.60
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PACE Senior Care Partners |
$80.37
|
| Rate for Payer: PACE SWMI |
$84.60
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.60
|
| Rate for Payer: UHC Exchange |
$84.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 68084078211
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.32
|
| Rate for Payer: UHC Core |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.98
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$383.05
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$344.75 |
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: Aetna Medicare |
$99.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.70
|
| Rate for Payer: BCBS Complete |
$153.22
|
| Rate for Payer: BCBS MAPPO |
$95.76
|
| Rate for Payer: BCBS Trust/PPO |
$314.91
|
| Rate for Payer: BCN Commercial |
$297.82
|
| Rate for Payer: BCN Medicare Advantage |
$95.76
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$344.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.59
|
| Rate for Payer: Nomi Health Commercial |
$314.10
|
| Rate for Payer: PACE Senior Care Partners |
$90.97
|
| Rate for Payer: PACE SWMI |
$95.76
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: PHP Medicare Advantage |
$95.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.98
|
| Rate for Payer: Priority Health HMO/PPO |
$333.25
|
| Rate for Payer: Priority Health Medicare |
$96.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.64
|
| Rate for Payer: Railroad Medicare Medicare |
$95.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.08
|
| Rate for Payer: UHC Core |
$319.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.76
|
| Rate for Payer: UHC Exchange |
$95.76
|
| Rate for Payer: UHC Medicare Advantage |
$95.76
|
| Rate for Payer: VA VA |
$95.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.29
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.13
|
| Rate for Payer: BCN Commercial |
$2.97
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.15
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health HMO/PPO |
$3.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
NDC 68084078211
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.83
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.66
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.66
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: PACE Senior Care Partners |
$0.63
|
| Rate for Payer: PACE SWMI |
$0.66
|
| Rate for Payer: PHP Commercial |
$2.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2.30
|
| Rate for Payer: Priority Health Medicare |
$0.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: Railroad Medicare Medicare |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.32
|
| Rate for Payer: UHC Core |
$2.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: VA VA |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.98
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$347.80
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.07 |
| Max. Negotiated Rate |
$313.02 |
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: BCBS Trust/PPO |
$283.91
|
| Rate for Payer: BCN Commercial |
$268.78
|
| Rate for Payer: Cash Price |
$278.24
|
| Rate for Payer: Cofinity Commercial |
$299.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.24
|
| Rate for Payer: Healthscope Commercial |
$313.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.63
|
| Rate for Payer: Nomi Health Commercial |
$285.20
|
| Rate for Payer: PHP Commercial |
$295.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.07
|
| Rate for Payer: Priority Health HMO/PPO |
$302.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.06
|
| Rate for Payer: UHC Core |
$290.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.85
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.20
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.15
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health HMO/PPO |
$3.34
|
| Rate for Payer: Priority Health Medicare |
$0.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.96
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$347.80
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$313.02 |
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: Aetna Medicare |
$90.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.69
|
| Rate for Payer: BCBS Complete |
$139.12
|
| Rate for Payer: BCBS MAPPO |
$86.95
|
| Rate for Payer: BCBS Trust/PPO |
$285.93
|
| Rate for Payer: BCN Commercial |
$270.41
|
| Rate for Payer: BCN Medicare Advantage |
$86.95
|
| Rate for Payer: Cash Price |
$278.24
|
| Rate for Payer: Cofinity Commercial |
$299.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.95
|
| Rate for Payer: Healthscope Commercial |
$313.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.63
|
| Rate for Payer: Nomi Health Commercial |
$285.20
|
| Rate for Payer: PACE Senior Care Partners |
$82.60
|
| Rate for Payer: PACE SWMI |
$86.95
|
| Rate for Payer: PHP Commercial |
$295.63
|
| Rate for Payer: PHP Medicare Advantage |
$86.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.07
|
| Rate for Payer: Priority Health HMO/PPO |
$302.59
|
| Rate for Payer: Priority Health Medicare |
$87.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.03
|
| Rate for Payer: Railroad Medicare Medicare |
$86.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.06
|
| Rate for Payer: UHC Core |
$290.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.95
|
| Rate for Payer: UHC Exchange |
$86.95
|
| Rate for Payer: UHC Medicare Advantage |
$86.95
|
| Rate for Payer: VA VA |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.85
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$383.05
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$344.75 |
| Rate for Payer: Aetna Commercial |
$325.59
|
| Rate for Payer: BCBS Trust/PPO |
$312.68
|
| Rate for Payer: BCN Commercial |
$296.02
|
| Rate for Payer: Cash Price |
$306.44
|
| Rate for Payer: Cofinity Commercial |
$329.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.44
|
| Rate for Payer: Healthscope Commercial |
$344.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.59
|
| Rate for Payer: Nomi Health Commercial |
$314.10
|
| Rate for Payer: PHP Commercial |
$325.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.98
|
| Rate for Payer: Priority Health HMO/PPO |
$333.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.08
|
| Rate for Payer: UHC Core |
$319.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.29
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.12 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: Aetna Medicare |
$298.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.36
|
| Rate for Payer: BCBS Complete |
$459.98
|
| Rate for Payer: BCBS MAPPO |
$287.49
|
| Rate for Payer: BCBS Trust/PPO |
$945.38
|
| Rate for Payer: BCN Commercial |
$894.09
|
| Rate for Payer: BCN Medicare Advantage |
$287.49
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.49
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: Nomi Health Commercial |
$942.97
|
| Rate for Payer: PACE Senior Care Partners |
$273.12
|
| Rate for Payer: PACE SWMI |
$287.49
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: PHP Medicare Advantage |
$287.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,000.47
|
| Rate for Payer: Priority Health Medicare |
$290.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.47
|
| Rate for Payer: Railroad Medicare Medicare |
$287.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.96
|
| Rate for Payer: UHC Core |
$960.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.49
|
| Rate for Payer: UHC Exchange |
$287.49
|
| Rate for Payer: UHC Medicare Advantage |
$287.49
|
| Rate for Payer: VA VA |
$287.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$228.95
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.82 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: BCBS Trust/PPO |
$186.89
|
| Rate for Payer: BCN Commercial |
$176.93
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: Nomi Health Commercial |
$187.74
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health HMO/PPO |
$199.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.48
|
| Rate for Payer: UHC Core |
$191.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
NDC 55111053301
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: BCBS Trust/PPO |
$310.19
|
| Rate for Payer: BCN Commercial |
$293.66
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Nomi Health Commercial |
$311.60
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.00
|
| Rate for Payer: Priority Health HMO/PPO |
$330.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$228.95
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna Medicare |
$59.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.55
|
| Rate for Payer: BCBS Complete |
$91.58
|
| Rate for Payer: BCBS MAPPO |
$57.24
|
| Rate for Payer: BCBS Trust/PPO |
$188.22
|
| Rate for Payer: BCN Commercial |
$178.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.24
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.24
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: Nomi Health Commercial |
$187.74
|
| Rate for Payer: PACE Senior Care Partners |
$54.38
|
| Rate for Payer: PACE SWMI |
$57.24
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: PHP Medicare Advantage |
$57.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health HMO/PPO |
$199.19
|
| Rate for Payer: Priority Health Medicare |
$57.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.40
|
| Rate for Payer: Railroad Medicare Medicare |
$57.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.48
|
| Rate for Payer: UHC Core |
$191.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.24
|
| Rate for Payer: UHC Exchange |
$57.24
|
| Rate for Payer: UHC Medicare Advantage |
$57.24
|
| Rate for Payer: VA VA |
$57.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
NDC 55111053301
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.75
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: BCBS MAPPO |
$95.00
|
| Rate for Payer: BCBS Trust/PPO |
$312.40
|
| Rate for Payer: BCN Commercial |
$295.45
|
| Rate for Payer: BCN Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Nomi Health Commercial |
$311.60
|
| Rate for Payer: PACE Senior Care Partners |
$90.25
|
| Rate for Payer: PACE SWMI |
$95.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: PHP Medicare Advantage |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.00
|
| Rate for Payer: Priority Health HMO/PPO |
$330.60
|
| Rate for Payer: Priority Health Medicare |
$95.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.60
|
| Rate for Payer: Railroad Medicare Medicare |
$95.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.00
|
| Rate for Payer: UHC Exchange |
$95.00
|
| Rate for Payer: UHC Medicare Advantage |
$95.00
|
| Rate for Payer: VA VA |
$95.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$747.47 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: BCBS Trust/PPO |
$938.71
|
| Rate for Payer: BCN Commercial |
$888.69
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: Nomi Health Commercial |
$942.97
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,000.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.96
|
| Rate for Payer: UHC Core |
$960.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna Medicare |
$159.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.10
|
| Rate for Payer: BCBS Complete |
$244.61
|
| Rate for Payer: BCBS MAPPO |
$152.88
|
| Rate for Payer: BCBS Trust/PPO |
$502.73
|
| Rate for Payer: BCN Commercial |
$475.46
|
| Rate for Payer: BCN Medicare Advantage |
$152.88
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: Nomi Health Commercial |
$501.45
|
| Rate for Payer: PACE Senior Care Partners |
$145.24
|
| Rate for Payer: PACE SWMI |
$152.88
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health HMO/PPO |
$532.02
|
| Rate for Payer: Priority Health Medicare |
$154.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.72
|
| Rate for Payer: Railroad Medicare Medicare |
$152.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.14
|
| Rate for Payer: UHC Core |
$510.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.88
|
| Rate for Payer: UHC Exchange |
$152.88
|
| Rate for Payer: UHC Medicare Advantage |
$152.88
|
| Rate for Payer: VA VA |
$152.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.46
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO |
$6.84
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Core |
$6.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.97
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO |
$6.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Core |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$604.80
|
|
|
Service Code
|
NDC 00904636461
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$514.08
|
| Rate for Payer: BCBS Trust/PPO |
$493.70
|
| Rate for Payer: BCN Commercial |
$467.39
|
| Rate for Payer: Cash Price |
$483.84
|
| Rate for Payer: Cofinity Commercial |
$520.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.84
|
| Rate for Payer: Healthscope Commercial |
$544.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.08
|
| Rate for Payer: Nomi Health Commercial |
$495.94
|
| Rate for Payer: PHP Commercial |
$514.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health HMO/PPO |
$526.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.22
|
| Rate for Payer: UHC Core |
$505.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$263.15
|
|
|
Service Code
|
NDC 65162075710
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.68
|
| Rate for Payer: BCBS Trust/PPO |
$214.81
|
| Rate for Payer: BCN Commercial |
$203.36
|
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Cofinity Commercial |
$226.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.52
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.68
|
| Rate for Payer: Nomi Health Commercial |
$215.78
|
| Rate for Payer: PHP Commercial |
$223.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$228.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.57
|
| Rate for Payer: UHC Core |
$219.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.36
|
|
