|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$5,174.79
|
|
|
Service Code
|
APR-DRG 2842
|
| Min. Negotiated Rate |
$4,928.37 |
| Max. Negotiated Rate |
$5,174.79 |
| Rate for Payer: BCBS Complete |
$5,174.79
|
| Rate for Payer: Mclaren Medicaid |
$4,928.37
|
| Rate for Payer: Meridian Medicaid |
$5,174.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,928.37
|
| Rate for Payer: UHC Medicaid |
$4,928.37
|
| Rate for Payer: UHCCP Medicaid |
$4,928.37
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$8,680.04
|
|
|
Service Code
|
APR-DRG 2844
|
| Min. Negotiated Rate |
$8,266.71 |
| Max. Negotiated Rate |
$8,680.04 |
| Rate for Payer: BCBS Complete |
$8,680.04
|
| Rate for Payer: Mclaren Medicaid |
$8,266.71
|
| Rate for Payer: Meridian Medicaid |
$8,680.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,266.71
|
| Rate for Payer: UHC Medicaid |
$8,266.71
|
| Rate for Payer: UHCCP Medicaid |
$8,266.71
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$6,586.15
|
|
|
Service Code
|
APR-DRG 2843
|
| Min. Negotiated Rate |
$6,272.52 |
| Max. Negotiated Rate |
$6,586.15 |
| Rate for Payer: BCBS Complete |
$6,586.15
|
| Rate for Payer: Mclaren Medicaid |
$6,272.52
|
| Rate for Payer: Meridian Medicaid |
$6,586.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,272.52
|
| Rate for Payer: UHC Medicaid |
$6,272.52
|
| Rate for Payer: UHCCP Medicaid |
$6,272.52
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$12,312.02
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$11,725.73 |
| Max. Negotiated Rate |
$12,312.02 |
| Rate for Payer: BCBS Complete |
$12,312.02
|
| Rate for Payer: Mclaren Medicaid |
$11,725.73
|
| Rate for Payer: Meridian Medicaid |
$12,312.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,725.73
|
| Rate for Payer: UHC Medicaid |
$11,725.73
|
| Rate for Payer: UHCCP Medicaid |
$11,725.73
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$6,132.87
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$5,840.83 |
| Max. Negotiated Rate |
$6,132.87 |
| Rate for Payer: BCBS Complete |
$6,132.87
|
| Rate for Payer: Mclaren Medicaid |
$5,840.83
|
| Rate for Payer: Meridian Medicaid |
$6,132.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,840.83
|
| Rate for Payer: UHC Medicaid |
$5,840.83
|
| Rate for Payer: UHCCP Medicaid |
$5,840.83
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$4,077.89
|
|
|
Service Code
|
APR-DRG 2822
|
| Min. Negotiated Rate |
$3,883.70 |
| Max. Negotiated Rate |
$4,077.89 |
| Rate for Payer: BCBS Complete |
$4,077.89
|
| Rate for Payer: Mclaren Medicaid |
$3,883.70
|
| Rate for Payer: Meridian Medicaid |
$4,077.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,883.70
|
| Rate for Payer: UHC Medicaid |
$3,883.70
|
| Rate for Payer: UHCCP Medicaid |
$3,883.70
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$3,004.65
|
|
|
Service Code
|
APR-DRG 2821
|
| Min. Negotiated Rate |
$2,861.57 |
| Max. Negotiated Rate |
$3,004.65 |
| Rate for Payer: BCBS Complete |
$3,004.65
|
| Rate for Payer: Mclaren Medicaid |
$2,861.57
|
| Rate for Payer: Meridian Medicaid |
$3,004.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,861.57
|
| Rate for Payer: UHC Medicaid |
$2,861.57
|
| Rate for Payer: UHCCP Medicaid |
$2,861.57
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 68382010601
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.26 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: BCBS Trust/PPO |
$249.50
|
| Rate for Payer: BCN Commercial |
$249.50
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084031311
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.72
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$1.13
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Mclaren Medicaid |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.19
|
| Rate for Payer: Meridian Medicaid |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.39
|
| Rate for Payer: PACE Senior Care Partners |
$1.07
|
| Rate for Payer: PACE SWMI |
$1.13
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$1.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.93
|
| Rate for Payer: Priority Health Medicare |
$1.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.98
|
| Rate for Payer: UHC Core |
$3.77
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicaid |
$0.80
|
| Rate for Payer: UHC Medicare Advantage |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$0.80
|
| Rate for Payer: VA VA |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$410.40
|
|
|
Service Code
|
NDC 00904661561
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.64 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: BCBS Trust/PPO |
$338.95
|
| Rate for Payer: BCN Commercial |
$338.95
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Nomi Health Commercial |
$336.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.80
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$357.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.15
|
| Rate for Payer: UHC Core |
$342.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68084031311
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCN Commercial |
$3.73
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.98
|
| Rate for Payer: UHC Core |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68084031301
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.55 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$117.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.00
|
| Rate for Payer: BCBS Complete |
$83.52
|
| Rate for Payer: BCBS MAPPO |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$370.93
|
| Rate for Payer: BCN Commercial |
$370.93
|
| Rate for Payer: BCN Medicare Advantage |
$112.80
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Mclaren Medicaid |
$79.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.44
|
| Rate for Payer: Meridian Medicaid |
$83.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.40
|
| Rate for Payer: PACE Senior Care Partners |
$107.16
|
| Rate for Payer: PACE SWMI |
$112.80
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: PHP Medicare Advantage |
$112.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Medicare |
$113.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.04
|
| Rate for Payer: Railroad Medicare Medicare |
$112.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: UHC Exchange |
$112.80
|
| Rate for Payer: UHC Medicaid |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$112.80
|
| Rate for Payer: UHCCP Medicaid |
$79.55
|
| Rate for Payer: VA VA |
$112.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 68382010601
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.41
|
| Rate for Payer: BCBS Complete |
$55.92
|
| Rate for Payer: BCBS MAPPO |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$75.53
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.53
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Mclaren Medicaid |
$53.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.30
|
| Rate for Payer: Meridian Medicaid |
$55.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.57
|
| Rate for Payer: PACE Senior Care Partners |
$71.75
|
| Rate for Payer: PACE SWMI |
$75.53
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: PHP Medicare Advantage |
$75.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.26
|
| Rate for Payer: Railroad Medicare Medicare |
$75.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicaid |
$53.26
|
| Rate for Payer: UHC Medicare Advantage |
$75.53
|
| Rate for Payer: UHCCP Medicaid |
$53.26
|
| Rate for Payer: VA VA |
$75.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 68084031301
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.04 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: BCBS Trust/PPO |
$372.65
|
| Rate for Payer: BCN Commercial |
$372.65
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.40
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE
|
Facility
|
OP
|
$410.40
|
|
|
Service Code
|
NDC 00904661561
|
| Hospital Charge Code |
27631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Medicare |
$106.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.25
|
| Rate for Payer: BCBS Complete |
$75.97
|
| Rate for Payer: BCBS MAPPO |
$102.60
|
| Rate for Payer: BCBS Trust/PPO |
$337.39
|
| Rate for Payer: BCN Commercial |
$337.39
|
| Rate for Payer: BCN Medicare Advantage |
$102.60
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Mclaren Medicaid |
$72.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.73
|
| Rate for Payer: Meridian Medicaid |
$75.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Nomi Health Commercial |
$336.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.80
|
| Rate for Payer: PACE Senior Care Partners |
$97.47
|
| Rate for Payer: PACE SWMI |
$102.60
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Medicare Advantage |
$102.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$357.05
|
| Rate for Payer: Priority Health Medicare |
$103.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.64
|
| Rate for Payer: Railroad Medicare Medicare |
$102.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.15
|
| Rate for Payer: UHC Core |
$342.68
|
| Rate for Payer: UHC Exchange |
$102.60
|
| Rate for Payer: UHC Medicaid |
$72.35
|
| Rate for Payer: UHC Medicare Advantage |
$102.60
|
| Rate for Payer: UHCCP Medicaid |
$72.35
|
| Rate for Payer: VA VA |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
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 |
$65.87 |
| 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 |
$69.16
|
| Rate for Payer: BCBS MAPPO |
$93.41
|
| Rate for Payer: BCBS Trust/PPO |
$307.18
|
| Rate for Payer: BCN Commercial |
$307.18
|
| 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: Mclaren Medicaid |
$65.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.08
|
| Rate for Payer: Meridian Medicaid |
$69.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| 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 Choice Medicaid |
$65.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.08
|
| Rate for Payer: Priority Health Medicare |
$94.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.06
|
| 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 Exchange |
$93.41
|
| Rate for Payer: UHC Medicaid |
$65.87
|
| Rate for Payer: UHC Medicare Advantage |
$93.41
|
| Rate for Payer: UHCCP Medicaid |
$65.87
|
| 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
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 00904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.26 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: BCBS Trust/PPO |
$275.60
|
| Rate for Payer: BCN Commercial |
$275.60
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 00904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$86.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$274.33
|
| Rate for Payer: BCN Commercial |
$274.33
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Mclaren Medicaid |
$58.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.60
|
| Rate for Payer: Meridian Medicaid |
$61.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Medicare |
$84.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.26
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: UHC Exchange |
$83.42
|
| Rate for Payer: UHC Medicaid |
$58.83
|
| Rate for Payer: UHC Medicare Advantage |
$83.42
|
| Rate for Payer: UHCCP Medicaid |
$58.83
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 68084077601
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.06 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: BCBS Trust/PPO |
$308.60
|
| Rate for Payer: BCN Commercial |
$308.60
|
| 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: Healthscope Commercial |
$336.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.81
|
| Rate for Payer: UHC Core |
$312.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 62756079788
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.73 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$225.14
|
| Rate for Payer: BCN Commercial |
$225.14
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
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 |
$28.59 |
| 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 |
$30.01
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCN Commercial |
$133.30
|
| 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: Mclaren Medicaid |
$28.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.56
|
| Rate for Payer: Meridian Medicaid |
$30.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| 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 Choice Medicaid |
$28.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Medicare |
$40.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| 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 Exchange |
$40.54
|
| Rate for Payer: UHC Medicaid |
$28.59
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: UHCCP Medicaid |
$28.59
|
| 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
|
$3.74
|
|
|
Service Code
|
NDC 68084077611
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Commercial |
$3.09
|
| 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: Opus (Opus Packaging Group) HMA |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| 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
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 57237004701
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: BCBS Trust/PPO |
$133.92
|
| Rate for Payer: BCN Commercial |
$133.92
|
| 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: Healthscope Commercial |
$145.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Nomi Health Commercial |
$132.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.69
|
| Rate for Payer: UHC Core |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
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 |
$0.66 |
| 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 |
$0.69
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| 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: Mclaren Medicaid |
$0.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: Meridian Medicaid |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.81
|
| 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 Choice Medicaid |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| 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 Exchange |
$0.94
|
| Rate for Payer: UHC Medicaid |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: UHCCP Medicaid |
$0.66
|
| 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
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 62756079788
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$50.46
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$224.10
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Mclaren Medicaid |
$48.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: Meridian Medicaid |
$50.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.73
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicaid |
$48.06
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: UHCCP Medicaid |
$48.06
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
