|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$0.47
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Mclaren Medicaid |
$0.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Meridian Medicaid |
$0.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicaid |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: UHCCP Medicaid |
$0.45
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: BCBS Trust/PPO |
$211.06
|
| Rate for Payer: BCN Commercial |
$211.06
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Nomi Health Commercial |
$209.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.88
|
| Rate for Payer: UHC Core |
$213.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.97 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: BCBS Trust/PPO |
$314.42
|
| Rate for Payer: BCN Commercial |
$314.42
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$255.55
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Medicare |
$66.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.86
|
| Rate for Payer: BCBS Complete |
$47.30
|
| Rate for Payer: BCBS MAPPO |
$63.89
|
| Rate for Payer: BCBS Trust/PPO |
$210.09
|
| Rate for Payer: BCN Commercial |
$210.09
|
| Rate for Payer: BCN Medicare Advantage |
$63.89
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.89
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Mclaren Medicaid |
$45.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.08
|
| Rate for Payer: Meridian Medicaid |
$47.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Nomi Health Commercial |
$209.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PACE Senior Care Partners |
$60.69
|
| Rate for Payer: PACE SWMI |
$63.89
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: PHP Medicare Advantage |
$63.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.33
|
| Rate for Payer: Priority Health Medicare |
$64.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.86
|
| Rate for Payer: Railroad Medicare Medicare |
$63.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.88
|
| Rate for Payer: UHC Core |
$213.38
|
| Rate for Payer: UHC Exchange |
$63.89
|
| Rate for Payer: UHC Medicaid |
$45.05
|
| Rate for Payer: UHC Medicare Advantage |
$63.89
|
| Rate for Payer: UHCCP Medicaid |
$45.05
|
| Rate for Payer: VA VA |
$63.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
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 |
$1.84 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| 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: Opus (Opus Packaging Group) HMA |
$1.98
|
| Rate for Payer: PHP Commercial |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Core |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
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 |
$0.47 |
| 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 |
$0.49
|
| Rate for Payer: BCBS MAPPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| 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: Mclaren Medicaid |
$0.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: Meridian Medicaid |
$0.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.98
|
| 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 Choice Medicaid |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.30
|
| Rate for Payer: Priority Health Medicare |
$0.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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 Exchange |
$0.66
|
| Rate for Payer: UHC Medicaid |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.66
|
| Rate for Payer: UHCCP Medicaid |
$0.47
|
| 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
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.12 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$98.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.97
|
| Rate for Payer: BCBS Complete |
$70.47
|
| Rate for Payer: BCBS MAPPO |
$95.17
|
| Rate for Payer: BCBS Trust/PPO |
$312.97
|
| Rate for Payer: BCN Commercial |
$312.97
|
| Rate for Payer: BCN Medicare Advantage |
$95.17
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.17
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Mclaren Medicaid |
$67.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.93
|
| Rate for Payer: Meridian Medicaid |
$70.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PACE Senior Care Partners |
$90.42
|
| Rate for Payer: PACE SWMI |
$95.17
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.21
|
| Rate for Payer: Priority Health Medicare |
$96.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.97
|
| Rate for Payer: Railroad Medicare Medicare |
$95.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.02
|
| Rate for Payer: UHC Core |
$317.88
|
| Rate for Payer: UHC Exchange |
$95.17
|
| Rate for Payer: UHC Medicaid |
$67.12
|
| Rate for Payer: UHC Medicare Advantage |
$95.17
|
| Rate for Payer: UHCCP Medicaid |
$67.12
|
| Rate for Payer: VA VA |
$95.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$121.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.14
|
| Rate for Payer: BCBS Complete |
$86.56
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$384.46
|
| Rate for Payer: BCN Medicare Advantage |
$116.91
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.91
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Mclaren Medicaid |
$82.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: Meridian Medicaid |
$86.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PACE Senior Care Partners |
$111.07
|
| Rate for Payer: PACE SWMI |
$116.91
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: PHP Medicare Advantage |
$116.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| Rate for Payer: Railroad Medicare Medicare |
$116.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicaid |
$82.45
|
| Rate for Payer: UHC Medicare Advantage |
$116.91
|
| Rate for Payer: UHCCP Medicaid |
$82.45
|
| Rate for Payer: VA VA |
$116.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.48 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$386.23
|
| Rate for Payer: BCN Commercial |
$386.23
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
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 |
$66.99 |
| 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 |
$70.34
|
| Rate for Payer: BCBS MAPPO |
$95.00
|
| Rate for Payer: BCBS Trust/PPO |
$312.40
|
| Rate for Payer: BCN Commercial |
$312.40
|
| 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: Mclaren Medicaid |
$66.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.75
|
| Rate for Payer: Meridian Medicaid |
$70.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Nomi Health Commercial |
$311.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| 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 Choice Medicaid |
$66.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$330.60
|
| Rate for Payer: Priority Health Medicare |
$95.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.48
|
| 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 Exchange |
$95.00
|
| Rate for Payer: UHC Medicaid |
$66.99
|
| Rate for Payer: UHC Medicare Advantage |
$95.00
|
| Rate for Payer: UHCCP Medicaid |
$66.99
|
| 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
|
OP
|
$156.75
|
|
|
Service Code
|
NDC 50268025915
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$141.07 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: Aetna Medicare |
$40.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.98
|
| Rate for Payer: BCBS Complete |
$29.01
|
| Rate for Payer: BCBS MAPPO |
$39.19
|
| Rate for Payer: BCBS Trust/PPO |
$128.86
|
| Rate for Payer: BCN Commercial |
$128.86
|
| Rate for Payer: BCN Medicare Advantage |
$39.19
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cofinity Commercial |
$134.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.19
|
| Rate for Payer: Healthscope Commercial |
$141.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.56
|
| Rate for Payer: Mclaren Medicaid |
$27.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.15
|
| Rate for Payer: Meridian Medicaid |
$29.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.24
|
| Rate for Payer: Nomi Health Commercial |
$128.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.56
|
| Rate for Payer: PACE Senior Care Partners |
$37.23
|
| Rate for Payer: PACE SWMI |
$39.19
|
| Rate for Payer: PHP Commercial |
$133.24
|
| Rate for Payer: PHP Medicare Advantage |
$39.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.37
|
| Rate for Payer: Priority Health Medicare |
$39.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.10
|
| Rate for Payer: Railroad Medicare Medicare |
$39.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.94
|
| Rate for Payer: UHC Core |
$130.89
|
| Rate for Payer: UHC Exchange |
$39.19
|
| Rate for Payer: UHC Medicaid |
$27.64
|
| Rate for Payer: UHC Medicare Advantage |
$39.19
|
| Rate for Payer: UHCCP Medicaid |
$27.64
|
| Rate for Payer: VA VA |
$39.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.56
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$156.75
|
|
|
Service Code
|
NDC 50268025915
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.10 |
| Max. Negotiated Rate |
$141.07 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: BCBS Trust/PPO |
$129.46
|
| Rate for Payer: BCN Commercial |
$129.46
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cofinity Commercial |
$134.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.40
|
| Rate for Payer: Healthscope Commercial |
$141.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.24
|
| Rate for Payer: Nomi Health Commercial |
$128.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.56
|
| Rate for Payer: PHP Commercial |
$133.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.94
|
| Rate for Payer: UHC Core |
$130.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.56
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 50268025911
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.79
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.79
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Mclaren Medicaid |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: Meridian Medicaid |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PACE Senior Care Partners |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.79
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.73
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: Railroad Medicare Medicare |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Medicaid |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.79
|
| Rate for Payer: UHCCP Medicaid |
$0.55
|
| Rate for Payer: VA VA |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
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 |
$264.48 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.84
|
| Rate for Payer: BCN Commercial |
$313.84
|
| 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: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$330.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.48
|
| 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
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 50268025911
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.59
|
| Rate for Payer: BCN Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Nomi Health Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$214.70
|
|
|
Service Code
|
NDC 65162075710
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$182.50
|
| Rate for Payer: BCBS Trust/PPO |
$177.32
|
| Rate for Payer: BCN Commercial |
$177.32
|
| Rate for Payer: Cash Price |
$171.76
|
| Rate for Payer: Cofinity Commercial |
$184.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.76
|
| Rate for Payer: Healthscope Commercial |
$193.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.50
|
| Rate for Payer: Nomi Health Commercial |
$176.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.03
|
| Rate for Payer: PHP Commercial |
$182.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.94
|
| Rate for Payer: UHC Core |
$179.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.03
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$799.20
|
|
|
Service Code
|
NDC 68084041501
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.24 |
| Max. Negotiated Rate |
$719.28 |
| Rate for Payer: Aetna Commercial |
$679.32
|
| Rate for Payer: BCBS Trust/PPO |
$660.06
|
| Rate for Payer: BCN Commercial |
$660.06
|
| Rate for Payer: Cash Price |
$639.36
|
| Rate for Payer: Cofinity Commercial |
$687.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.36
|
| Rate for Payer: Healthscope Commercial |
$719.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.32
|
| Rate for Payer: Nomi Health Commercial |
$655.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.40
|
| Rate for Payer: PHP Commercial |
$679.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$695.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$556.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$703.30
|
| Rate for Payer: UHC Core |
$667.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.40
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$142.13
|
|
|
Service Code
|
NDC 50268026013
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$120.81
|
| Rate for Payer: Aetna Medicare |
$36.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.42
|
| Rate for Payer: BCBS Complete |
$26.31
|
| Rate for Payer: BCBS MAPPO |
$35.53
|
| Rate for Payer: BCBS Trust/PPO |
$116.85
|
| Rate for Payer: BCN Commercial |
$116.85
|
| Rate for Payer: BCN Medicare Advantage |
$35.53
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$122.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.53
|
| Rate for Payer: Healthscope Commercial |
$127.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.60
|
| Rate for Payer: Mclaren Medicaid |
$25.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.31
|
| Rate for Payer: Meridian Medicaid |
$26.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.81
|
| Rate for Payer: Nomi Health Commercial |
$116.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.60
|
| Rate for Payer: PACE Senior Care Partners |
$33.76
|
| Rate for Payer: PACE SWMI |
$35.53
|
| Rate for Payer: PHP Commercial |
$120.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.65
|
| Rate for Payer: Priority Health Medicare |
$35.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.92
|
| Rate for Payer: Railroad Medicare Medicare |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.07
|
| Rate for Payer: UHC Core |
$118.68
|
| Rate for Payer: UHC Exchange |
$35.53
|
| Rate for Payer: UHC Medicaid |
$25.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.53
|
| Rate for Payer: UHCCP Medicaid |
$25.06
|
| Rate for Payer: VA VA |
$35.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$843.84
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$759.46 |
| Rate for Payer: Aetna Commercial |
$717.26
|
| Rate for Payer: Aetna Medicare |
$219.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.70
|
| Rate for Payer: BCBS Complete |
$156.19
|
| Rate for Payer: BCBS MAPPO |
$210.96
|
| Rate for Payer: BCBS Trust/PPO |
$693.72
|
| Rate for Payer: BCN Commercial |
$693.72
|
| Rate for Payer: BCN Medicare Advantage |
$210.96
|
| Rate for Payer: Cash Price |
$675.07
|
| Rate for Payer: Cofinity Commercial |
$725.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$675.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.96
|
| Rate for Payer: Healthscope Commercial |
$759.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.88
|
| Rate for Payer: Mclaren Medicaid |
$148.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.51
|
| Rate for Payer: Meridian Medicaid |
$156.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$717.26
|
| Rate for Payer: Nomi Health Commercial |
$691.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.88
|
| Rate for Payer: PACE Senior Care Partners |
$200.41
|
| Rate for Payer: PACE SWMI |
$210.96
|
| Rate for Payer: PHP Commercial |
$717.26
|
| Rate for Payer: PHP Medicare Advantage |
$210.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$734.14
|
| Rate for Payer: Priority Health Medicare |
$213.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$587.31
|
| Rate for Payer: Railroad Medicare Medicare |
$210.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.58
|
| Rate for Payer: UHC Core |
$704.61
|
| Rate for Payer: UHC Exchange |
$210.96
|
| Rate for Payer: UHC Medicaid |
$148.77
|
| Rate for Payer: UHC Medicare Advantage |
$210.96
|
| Rate for Payer: UHCCP Medicaid |
$148.77
|
| Rate for Payer: VA VA |
$210.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.88
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
NDC 50268026011
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Mclaren Medicaid |
$0.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.24
|
| Rate for Payer: Meridian Medicaid |
$0.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.12
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicaid |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: UHCCP Medicaid |
$0.84
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$142.13
|
|
|
Service Code
|
NDC 50268026013
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$117.39
|
| Rate for Payer: BCN Commercial |
$117.39
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$122.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.70
|
| Rate for Payer: Healthscope Commercial |
$127.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.81
|
| Rate for Payer: Nomi Health Commercial |
$116.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.60
|
| Rate for Payer: PHP Commercial |
$120.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.07
|
| Rate for Payer: UHC Core |
$118.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
NDC 50268026011
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$799.20
|
|
|
Service Code
|
NDC 68084041501
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.90 |
| Max. Negotiated Rate |
$719.28 |
| Rate for Payer: Aetna Commercial |
$679.32
|
| Rate for Payer: Aetna Medicare |
$207.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.75
|
| Rate for Payer: BCBS Complete |
$147.93
|
| Rate for Payer: BCBS MAPPO |
$199.80
|
| Rate for Payer: BCBS Trust/PPO |
$657.02
|
| Rate for Payer: BCN Commercial |
$657.02
|
| Rate for Payer: BCN Medicare Advantage |
$199.80
|
| Rate for Payer: Cash Price |
$639.36
|
| Rate for Payer: Cofinity Commercial |
$687.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.80
|
| Rate for Payer: Healthscope Commercial |
$719.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.40
|
| Rate for Payer: Mclaren Medicaid |
$140.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.79
|
| Rate for Payer: Meridian Medicaid |
$147.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.32
|
| Rate for Payer: Nomi Health Commercial |
$655.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.40
|
| Rate for Payer: PACE Senior Care Partners |
$189.81
|
| Rate for Payer: PACE SWMI |
$199.80
|
| Rate for Payer: PHP Commercial |
$679.32
|
| Rate for Payer: PHP Medicare Advantage |
$199.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$695.30
|
| Rate for Payer: Priority Health Medicare |
$201.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$556.24
|
| Rate for Payer: Railroad Medicare Medicare |
$199.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$703.30
|
| Rate for Payer: UHC Core |
$667.33
|
| Rate for Payer: UHC Exchange |
$199.80
|
| Rate for Payer: UHC Medicaid |
$140.90
|
| Rate for Payer: UHC Medicare Advantage |
$199.80
|
| Rate for Payer: UHCCP Medicaid |
$140.90
|
| Rate for Payer: VA VA |
$199.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.40
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS MAPPO |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.58
|
| Rate for Payer: BCN Commercial |
$6.58
|
| Rate for Payer: BCN Medicare Advantage |
$2.00
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Mclaren Medicaid |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.10
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.80
|
| Rate for Payer: Nomi Health Commercial |
$6.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
| Rate for Payer: PACE Senior Care Partners |
$1.90
|
| Rate for Payer: PACE SWMI |
$2.00
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.96
|
| Rate for Payer: Priority Health Medicare |
$2.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Exchange |
$2.00
|
| Rate for Payer: UHC Medicaid |
$1.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.00
|
| Rate for Payer: UHCCP Medicaid |
$1.41
|
| Rate for Payer: VA VA |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
