|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,224.45
|
|
|
Service Code
|
APR-DRG 5422
|
| Min. Negotiated Rate |
$3,070.91 |
| Max. Negotiated Rate |
$3,224.45 |
| Rate for Payer: BCBS Complete |
$3,224.45
|
| Rate for Payer: Mclaren Medicaid |
$3,070.91
|
| Rate for Payer: Meridian Medicaid |
$3,224.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,070.91
|
| Rate for Payer: UHC Medicaid |
$3,070.91
|
| Rate for Payer: UHCCP Medicaid |
$3,070.91
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$4,281.39
|
|
|
Service Code
|
APR-DRG 5423
|
| Min. Negotiated Rate |
$4,077.51 |
| Max. Negotiated Rate |
$4,281.39 |
| Rate for Payer: BCBS Complete |
$4,281.39
|
| Rate for Payer: Mclaren Medicaid |
$4,077.51
|
| Rate for Payer: Meridian Medicaid |
$4,281.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,077.51
|
| Rate for Payer: UHC Medicaid |
$4,077.51
|
| Rate for Payer: UHCCP Medicaid |
$4,077.51
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$11,555.33
|
|
|
Service Code
|
APR-DRG 5424
|
| Min. Negotiated Rate |
$11,005.08 |
| Max. Negotiated Rate |
$11,555.33 |
| Rate for Payer: BCBS Complete |
$11,555.33
|
| Rate for Payer: Mclaren Medicaid |
$11,005.08
|
| Rate for Payer: Meridian Medicaid |
$11,555.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,005.08
|
| Rate for Payer: UHC Medicaid |
$11,005.08
|
| Rate for Payer: UHCCP Medicaid |
$11,005.08
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$5,220.01
|
|
|
Service Code
|
APR-DRG 5413
|
| Min. Negotiated Rate |
$4,971.44 |
| Max. Negotiated Rate |
$5,220.01 |
| Rate for Payer: BCBS Complete |
$5,220.01
|
| Rate for Payer: Mclaren Medicaid |
$4,971.44
|
| Rate for Payer: Meridian Medicaid |
$5,220.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,971.44
|
| Rate for Payer: UHC Medicaid |
$4,971.44
|
| Rate for Payer: UHCCP Medicaid |
$4,971.44
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$5,366.20
|
|
|
Service Code
|
APR-DRG 5414
|
| Min. Negotiated Rate |
$5,110.66 |
| Max. Negotiated Rate |
$5,366.20 |
| Rate for Payer: BCBS Complete |
$5,366.20
|
| Rate for Payer: Mclaren Medicaid |
$5,110.66
|
| Rate for Payer: Meridian Medicaid |
$5,366.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,110.66
|
| Rate for Payer: UHC Medicaid |
$5,110.66
|
| Rate for Payer: UHCCP Medicaid |
$5,110.66
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,977.45
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$3,788.05 |
| Max. Negotiated Rate |
$3,977.45 |
| Rate for Payer: BCBS Complete |
$3,977.45
|
| Rate for Payer: Mclaren Medicaid |
$3,788.05
|
| Rate for Payer: Meridian Medicaid |
$3,977.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,788.05
|
| Rate for Payer: UHC Medicaid |
$3,788.05
|
| Rate for Payer: UHCCP Medicaid |
$3,788.05
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,089.84
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$2,942.70 |
| Max. Negotiated Rate |
$3,089.84 |
| Rate for Payer: BCBS Complete |
$3,089.84
|
| Rate for Payer: Mclaren Medicaid |
$2,942.70
|
| Rate for Payer: Meridian Medicaid |
$3,089.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,942.70
|
| Rate for Payer: UHC Medicaid |
$2,942.70
|
| Rate for Payer: UHCCP Medicaid |
$2,942.70
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$332.40
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.35 |
| Max. Negotiated Rate |
$299.16 |
| Rate for Payer: Aetna Commercial |
$282.54
|
| Rate for Payer: BCBS Trust/PPO |
$274.53
|
| Rate for Payer: BCN Commercial |
$274.53
|
| Rate for Payer: Cash Price |
$265.92
|
| Rate for Payer: Cofinity Commercial |
$285.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.92
|
| Rate for Payer: Healthscope Commercial |
$299.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.54
|
| Rate for Payer: Nomi Health Commercial |
$272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.30
|
| Rate for Payer: PHP Commercial |
$282.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$289.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.51
|
| Rate for Payer: UHC Core |
$277.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.30
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$296.49
|
|
|
Service Code
|
NDC 00904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.27 |
| Max. Negotiated Rate |
$266.84 |
| Rate for Payer: Aetna Commercial |
$252.02
|
| Rate for Payer: Aetna Medicare |
$77.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.65
|
| Rate for Payer: BCBS Complete |
$54.88
|
| Rate for Payer: BCBS MAPPO |
$74.12
|
| Rate for Payer: BCBS Trust/PPO |
$243.74
|
| Rate for Payer: BCN Commercial |
$243.74
|
| Rate for Payer: BCN Medicare Advantage |
$74.12
|
| Rate for Payer: Cash Price |
$237.19
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.12
|
| Rate for Payer: Healthscope Commercial |
$266.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.37
|
| Rate for Payer: Mclaren Medicaid |
$52.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.83
|
| Rate for Payer: Meridian Medicaid |
$54.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.02
|
| Rate for Payer: Nomi Health Commercial |
$243.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.37
|
| Rate for Payer: PACE Senior Care Partners |
$70.42
|
| Rate for Payer: PACE SWMI |
$74.12
|
| Rate for Payer: PHP Commercial |
$252.02
|
| Rate for Payer: PHP Medicare Advantage |
$74.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.95
|
| Rate for Payer: Priority Health Medicare |
$74.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.91
|
| Rate for Payer: UHC Core |
$247.57
|
| Rate for Payer: UHC Exchange |
$74.12
|
| Rate for Payer: UHC Medicaid |
$52.27
|
| Rate for Payer: UHC Medicare Advantage |
$74.12
|
| Rate for Payer: UHCCP Medicaid |
$52.27
|
| Rate for Payer: VA VA |
$74.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.37
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$76.76
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$66.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.41
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.25
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.57
|
| Rate for Payer: PHP Commercial |
$65.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.55
|
| Rate for Payer: UHC Core |
$64.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.57
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.01 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$530.40
|
| Rate for Payer: Aetna Medicare |
$162.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.00
|
| Rate for Payer: BCBS Complete |
$115.50
|
| Rate for Payer: BCBS MAPPO |
$156.00
|
| Rate for Payer: BCBS Trust/PPO |
$512.99
|
| Rate for Payer: BCN Commercial |
$512.99
|
| Rate for Payer: BCN Medicare Advantage |
$156.00
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cofinity Commercial |
$536.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.00
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.00
|
| Rate for Payer: Mclaren Medicaid |
$110.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.80
|
| Rate for Payer: Meridian Medicaid |
$115.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Nomi Health Commercial |
$511.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.00
|
| Rate for Payer: PACE Senior Care Partners |
$148.20
|
| Rate for Payer: PACE SWMI |
$156.00
|
| Rate for Payer: PHP Commercial |
$530.40
|
| Rate for Payer: PHP Medicare Advantage |
$156.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$542.88
|
| Rate for Payer: Priority Health Medicare |
$157.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.30
|
| Rate for Payer: Railroad Medicare Medicare |
$156.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.12
|
| Rate for Payer: UHC Core |
$521.04
|
| Rate for Payer: UHC Exchange |
$156.00
|
| Rate for Payer: UHC Medicaid |
$110.01
|
| Rate for Payer: UHC Medicare Advantage |
$156.00
|
| Rate for Payer: UHCCP Medicaid |
$110.01
|
| Rate for Payer: VA VA |
$156.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.00
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.08
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS MAPPO |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$5.47
|
| Rate for Payer: BCN Commercial |
$5.47
|
| Rate for Payer: BCN Medicare Advantage |
$1.66
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.99
|
| Rate for Payer: Mclaren Medicaid |
$1.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.75
|
| Rate for Payer: Meridian Medicaid |
$1.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.65
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.99
|
| Rate for Payer: PACE Senior Care Partners |
$1.58
|
| Rate for Payer: PACE SWMI |
$1.66
|
| Rate for Payer: PHP Commercial |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.79
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.85
|
| Rate for Payer: UHC Core |
$5.55
|
| Rate for Payer: UHC Exchange |
$1.66
|
| Rate for Payer: UHC Medicaid |
$1.17
|
| Rate for Payer: UHC Medicare Advantage |
$1.66
|
| Rate for Payer: UHCCP Medicaid |
$1.17
|
| Rate for Payer: VA VA |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.99
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: BCN Commercial |
$5.49
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.65
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.99
|
| Rate for Payer: PHP Commercial |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.85
|
| Rate for Payer: UHC Core |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.99
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$76.76
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: Aetna Medicare |
$19.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.99
|
| Rate for Payer: BCBS Complete |
$14.21
|
| Rate for Payer: BCBS MAPPO |
$19.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.10
|
| Rate for Payer: BCN Commercial |
$63.10
|
| Rate for Payer: BCN Medicare Advantage |
$19.19
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$66.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.57
|
| Rate for Payer: Mclaren Medicaid |
$13.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.15
|
| Rate for Payer: Meridian Medicaid |
$14.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.25
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.57
|
| Rate for Payer: PACE Senior Care Partners |
$18.23
|
| Rate for Payer: PACE SWMI |
$19.19
|
| Rate for Payer: PHP Commercial |
$65.25
|
| Rate for Payer: PHP Medicare Advantage |
$19.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.78
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.42
|
| Rate for Payer: Railroad Medicare Medicare |
$19.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.55
|
| Rate for Payer: UHC Core |
$64.09
|
| Rate for Payer: UHC Exchange |
$19.19
|
| Rate for Payer: UHC Medicaid |
$13.53
|
| Rate for Payer: UHC Medicare Advantage |
$19.19
|
| Rate for Payer: UHCCP Medicaid |
$13.53
|
| Rate for Payer: VA VA |
$19.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.57
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$296.49
|
|
|
Service Code
|
NDC 00904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.36 |
| Max. Negotiated Rate |
$266.84 |
| Rate for Payer: Aetna Commercial |
$252.02
|
| Rate for Payer: BCBS Trust/PPO |
$244.87
|
| Rate for Payer: BCN Commercial |
$244.87
|
| Rate for Payer: Cash Price |
$237.19
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.19
|
| Rate for Payer: Healthscope Commercial |
$266.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.02
|
| Rate for Payer: Nomi Health Commercial |
$243.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.37
|
| Rate for Payer: PHP Commercial |
$252.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.91
|
| Rate for Payer: UHC Core |
$247.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.37
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$332.40
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$299.16 |
| Rate for Payer: Aetna Commercial |
$282.54
|
| Rate for Payer: Aetna Medicare |
$86.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.88
|
| Rate for Payer: BCBS Complete |
$61.53
|
| Rate for Payer: BCBS MAPPO |
$83.10
|
| Rate for Payer: BCBS Trust/PPO |
$273.27
|
| Rate for Payer: BCN Commercial |
$273.27
|
| Rate for Payer: BCN Medicare Advantage |
$83.10
|
| Rate for Payer: Cash Price |
$265.92
|
| Rate for Payer: Cofinity Commercial |
$285.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.10
|
| Rate for Payer: Healthscope Commercial |
$299.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.30
|
| Rate for Payer: Mclaren Medicaid |
$58.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.25
|
| Rate for Payer: Meridian Medicaid |
$61.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.54
|
| Rate for Payer: Nomi Health Commercial |
$272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.30
|
| Rate for Payer: PACE Senior Care Partners |
$78.94
|
| Rate for Payer: PACE SWMI |
$83.10
|
| Rate for Payer: PHP Commercial |
$282.54
|
| Rate for Payer: PHP Medicare Advantage |
$83.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$289.19
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.35
|
| Rate for Payer: Railroad Medicare Medicare |
$83.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.51
|
| Rate for Payer: UHC Core |
$277.55
|
| Rate for Payer: UHC Exchange |
$83.10
|
| Rate for Payer: UHC Medicaid |
$58.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.10
|
| Rate for Payer: UHCCP Medicaid |
$58.60
|
| Rate for Payer: VA VA |
$83.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.30
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$74.67
|
|
|
Service Code
|
NDC 00378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$63.47
|
| Rate for Payer: Aetna Medicare |
$19.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.33
|
| Rate for Payer: BCBS Complete |
$13.82
|
| Rate for Payer: BCBS MAPPO |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCN Commercial |
$61.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.67
|
| Rate for Payer: Cash Price |
$59.74
|
| Rate for Payer: Cofinity Commercial |
$64.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.67
|
| Rate for Payer: Healthscope Commercial |
$67.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$13.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.60
|
| Rate for Payer: Meridian Medicaid |
$13.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.47
|
| Rate for Payer: Nomi Health Commercial |
$61.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.00
|
| Rate for Payer: PACE Senior Care Partners |
$17.73
|
| Rate for Payer: PACE SWMI |
$18.67
|
| Rate for Payer: PHP Commercial |
$63.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.96
|
| Rate for Payer: Priority Health Medicare |
$18.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.71
|
| Rate for Payer: UHC Core |
$62.35
|
| Rate for Payer: UHC Exchange |
$18.67
|
| Rate for Payer: UHC Medicaid |
$13.16
|
| Rate for Payer: UHC Medicare Advantage |
$18.67
|
| Rate for Payer: UHCCP Medicaid |
$13.16
|
| Rate for Payer: VA VA |
$18.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.00
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.30 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$530.40
|
| Rate for Payer: BCBS Trust/PPO |
$515.36
|
| Rate for Payer: BCN Commercial |
$515.36
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cofinity Commercial |
$536.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.20
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Nomi Health Commercial |
$511.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.00
|
| Rate for Payer: PHP Commercial |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$542.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.12
|
| Rate for Payer: UHC Core |
$521.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.00
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$74.67
|
|
|
Service Code
|
NDC 00378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$63.47
|
| Rate for Payer: BCBS Trust/PPO |
$61.67
|
| Rate for Payer: BCN Commercial |
$61.67
|
| Rate for Payer: Cash Price |
$59.74
|
| Rate for Payer: Cofinity Commercial |
$64.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.74
|
| Rate for Payer: Healthscope Commercial |
$67.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.47
|
| Rate for Payer: Nomi Health Commercial |
$61.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.00
|
| Rate for Payer: PHP Commercial |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.71
|
| Rate for Payer: UHC Core |
$62.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.00
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Commercial |
$23.78
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: Nomi Health Commercial |
$23.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.34
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Core |
$24.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS Complete |
$5.33
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCBS Trust/PPO |
$23.67
|
| Rate for Payer: BCN Commercial |
$23.67
|
| Rate for Payer: BCN Commercial |
$13.29
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: Meridian Medicaid |
$5.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$23.61
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: PACE Senior Care Partners |
$6.84
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$7.27
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.04
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.34
|
| Rate for Payer: UHC Core |
$24.04
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Exchange |
$7.20
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHC Medicaid |
$2.85
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$7.20
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: VA VA |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.39
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.56
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.62
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.39
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.62
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.39
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.60
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.68
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PACE Senior Care Partners |
$1.52
|
| Rate for Payer: PACE SWMI |
$1.60
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: PHP Medicare Advantage |
$1.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.56
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.62
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.39
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.28
|
| Rate for Payer: BCN Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.62
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
