|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$307.68
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.07 |
| Max. Negotiated Rate |
$276.91 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.15
|
| Rate for Payer: BCBS Complete |
$123.07
|
| Rate for Payer: BCBS MAPPO |
$76.92
|
| Rate for Payer: BCBS Trust/PPO |
$252.94
|
| Rate for Payer: BCN Commercial |
$239.22
|
| Rate for Payer: BCN Medicare Advantage |
$76.92
|
| Rate for Payer: Cash Price |
$246.14
|
| Rate for Payer: Cofinity Commercial |
$264.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.92
|
| Rate for Payer: Healthscope Commercial |
$276.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.53
|
| Rate for Payer: Nomi Health Commercial |
$252.30
|
| Rate for Payer: PACE Senior Care Partners |
$73.07
|
| Rate for Payer: PACE SWMI |
$76.92
|
| Rate for Payer: PHP Commercial |
$261.53
|
| Rate for Payer: PHP Medicare Advantage |
$76.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.99
|
| Rate for Payer: Priority Health HMO/PPO |
$267.68
|
| Rate for Payer: Priority Health Medicare |
$77.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.15
|
| Rate for Payer: Railroad Medicare Medicare |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.76
|
| Rate for Payer: UHC Core |
$256.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.92
|
| Rate for Payer: UHC Exchange |
$76.92
|
| Rate for Payer: UHC Medicare Advantage |
$76.92
|
| Rate for Payer: VA VA |
$76.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.76
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$274.62
|
|
|
Service Code
|
NDC 00904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.22 |
| Max. Negotiated Rate |
$247.16 |
| Rate for Payer: Aetna Commercial |
$233.43
|
| Rate for Payer: Aetna Medicare |
$71.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.82
|
| Rate for Payer: BCBS Complete |
$109.85
|
| Rate for Payer: BCBS MAPPO |
$68.66
|
| Rate for Payer: BCBS Trust/PPO |
$225.77
|
| Rate for Payer: BCN Commercial |
$213.52
|
| Rate for Payer: BCN Medicare Advantage |
$68.66
|
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Cofinity Commercial |
$236.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$247.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.43
|
| Rate for Payer: Nomi Health Commercial |
$225.19
|
| Rate for Payer: PACE Senior Care Partners |
$65.22
|
| Rate for Payer: PACE SWMI |
$68.66
|
| Rate for Payer: PHP Commercial |
$233.43
|
| Rate for Payer: PHP Medicare Advantage |
$68.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO |
$238.92
|
| Rate for Payer: Priority Health Medicare |
$69.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.00
|
| Rate for Payer: Railroad Medicare Medicare |
$68.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.67
|
| Rate for Payer: UHC Core |
$229.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.66
|
| Rate for Payer: UHC Exchange |
$68.66
|
| Rate for Payer: UHC Medicare Advantage |
$68.66
|
| Rate for Payer: VA VA |
$68.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.97
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$76.76
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.89 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$65.25
|
| Rate for Payer: BCBS Trust/PPO |
$62.66
|
| Rate for Payer: BCN Commercial |
$59.32
|
| 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: PHP Commercial |
$65.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.89
|
| Rate for Payer: Priority Health HMO/PPO |
$66.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.43
|
| 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
|
$494.88
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna Medicare |
$128.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.65
|
| Rate for Payer: BCBS Complete |
$197.95
|
| Rate for Payer: BCBS MAPPO |
$123.72
|
| Rate for Payer: BCBS Trust/PPO |
$406.84
|
| Rate for Payer: BCN Commercial |
$384.77
|
| Rate for Payer: BCN Medicare Advantage |
$123.72
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: Nomi Health Commercial |
$405.80
|
| Rate for Payer: PACE Senior Care Partners |
$117.53
|
| Rate for Payer: PACE SWMI |
$123.72
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: PHP Medicare Advantage |
$123.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.67
|
| Rate for Payer: Priority Health HMO/PPO |
$430.55
|
| Rate for Payer: Priority Health Medicare |
$124.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.57
|
| Rate for Payer: Railroad Medicare Medicare |
$123.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.49
|
| Rate for Payer: UHC Core |
$413.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.72
|
| Rate for Payer: UHC Exchange |
$123.72
|
| Rate for Payer: UHC Medicare Advantage |
$123.72
|
| Rate for Payer: VA VA |
$123.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$307.68
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.99 |
| Max. Negotiated Rate |
$276.91 |
| Rate for Payer: Aetna Commercial |
$261.53
|
| Rate for Payer: BCBS Trust/PPO |
$251.16
|
| Rate for Payer: BCN Commercial |
$237.78
|
| Rate for Payer: Cash Price |
$246.14
|
| Rate for Payer: Cofinity Commercial |
$264.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.14
|
| Rate for Payer: Healthscope Commercial |
$276.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.53
|
| Rate for Payer: Nomi Health Commercial |
$252.30
|
| Rate for Payer: PHP Commercial |
$261.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.99
|
| Rate for Payer: Priority Health HMO/PPO |
$267.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.76
|
| Rate for Payer: UHC Core |
$256.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.76
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$6.16
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$5.03
|
| Rate for Payer: BCN Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$5.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.93
|
| Rate for Payer: Healthscope Commercial |
$5.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.24
|
| Rate for Payer: Nomi Health Commercial |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.00
|
| Rate for Payer: Priority Health HMO/PPO |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC Core |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.62
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$6.16
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$5.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$5.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.24
|
| Rate for Payer: Nomi Health Commercial |
$5.05
|
| Rate for Payer: PACE Senior Care Partners |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$5.24
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.00
|
| Rate for Payer: Priority Health HMO/PPO |
$5.36
|
| Rate for Payer: Priority Health Medicare |
$1.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC Core |
$5.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Exchange |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: VA VA |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.62
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCN Commercial |
$12.57
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.04
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.05
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCN Commercial |
$12.57
|
| Rate for Payer: BCN Medicare Advantage |
$4.04
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: PACE Senior Care Partners |
$3.84
|
| Rate for Payer: PACE SWMI |
$4.04
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: PHP Medicare Advantage |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.04
|
| Rate for Payer: UHC Exchange |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: VA VA |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: Nomi Health Commercial |
$13.26
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health HMO/PPO |
$14.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.23
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
NDC 50268074811
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Medicare Advantage |
$1.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.46
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO |
$5.06
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UHC Medicare Advantage |
$1.46
|
| Rate for Payer: VA VA |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$3,078.59
|
|
|
Service Code
|
NDC 00078035934
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$731.17 |
| Max. Negotiated Rate |
$2,770.73 |
| Rate for Payer: Aetna Commercial |
$2,616.80
|
| Rate for Payer: Aetna Medicare |
$800.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$962.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$962.06
|
| Rate for Payer: BCBS Complete |
$1,231.44
|
| Rate for Payer: BCBS MAPPO |
$769.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,530.91
|
| Rate for Payer: BCN Commercial |
$2,393.60
|
| Rate for Payer: BCN Medicare Advantage |
$769.65
|
| Rate for Payer: Cash Price |
$2,462.87
|
| Rate for Payer: Cofinity Commercial |
$2,647.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,462.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.65
|
| Rate for Payer: Healthscope Commercial |
$2,770.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,308.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$808.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$885.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,616.80
|
| Rate for Payer: Nomi Health Commercial |
$2,524.44
|
| Rate for Payer: PACE Senior Care Partners |
$731.17
|
| Rate for Payer: PACE SWMI |
$769.65
|
| Rate for Payer: PHP Commercial |
$2,616.80
|
| Rate for Payer: PHP Medicare Advantage |
$769.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,001.08
|
| Rate for Payer: Priority Health HMO/PPO |
$2,678.37
|
| Rate for Payer: Priority Health Medicare |
$777.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,062.66
|
| Rate for Payer: Railroad Medicare Medicare |
$769.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,709.16
|
| Rate for Payer: UHC Core |
$2,570.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$769.65
|
| Rate for Payer: UHC Exchange |
$769.65
|
| Rate for Payer: UHC Medicare Advantage |
$769.65
|
| Rate for Payer: VA VA |
$769.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,308.94
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$290.88
|
|
|
Service Code
|
NDC 50268074815
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$261.79 |
| Rate for Payer: Aetna Commercial |
$247.25
|
| Rate for Payer: Aetna Medicare |
$75.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.90
|
| Rate for Payer: BCBS Complete |
$116.35
|
| Rate for Payer: BCBS MAPPO |
$72.72
|
| Rate for Payer: BCBS Trust/PPO |
$239.13
|
| Rate for Payer: BCN Commercial |
$226.16
|
| Rate for Payer: BCN Medicare Advantage |
$72.72
|
| Rate for Payer: Cash Price |
$232.70
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.72
|
| Rate for Payer: Healthscope Commercial |
$261.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.25
|
| Rate for Payer: Nomi Health Commercial |
$238.52
|
| Rate for Payer: PACE Senior Care Partners |
$69.08
|
| Rate for Payer: PACE SWMI |
$72.72
|
| Rate for Payer: PHP Commercial |
$247.25
|
| Rate for Payer: PHP Medicare Advantage |
$72.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.07
|
| Rate for Payer: Priority Health HMO/PPO |
$253.07
|
| Rate for Payer: Priority Health Medicare |
$73.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.89
|
| Rate for Payer: Railroad Medicare Medicare |
$72.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.97
|
| Rate for Payer: UHC Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.72
|
| Rate for Payer: UHC Exchange |
$72.72
|
| Rate for Payer: UHC Medicare Advantage |
$72.72
|
| Rate for Payer: VA VA |
$72.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.16
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$290.88
|
|
|
Service Code
|
NDC 50268074815
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$261.79 |
| Rate for Payer: Aetna Commercial |
$247.25
|
| Rate for Payer: BCBS Trust/PPO |
$237.45
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: Cash Price |
$232.70
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.70
|
| Rate for Payer: Healthscope Commercial |
$261.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.25
|
| Rate for Payer: Nomi Health Commercial |
$238.52
|
| Rate for Payer: PHP Commercial |
$247.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.07
|
| Rate for Payer: Priority Health HMO/PPO |
$253.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.97
|
| Rate for Payer: UHC Core |
$242.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.16
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
NDC 50268074811
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$4.75
|
| Rate for Payer: BCN Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO |
$5.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$538.08
|
|
|
Service Code
|
NDC 60687063401
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$484.27 |
| Rate for Payer: Aetna Commercial |
$457.37
|
| Rate for Payer: Aetna Medicare |
$139.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.15
|
| Rate for Payer: BCBS Complete |
$215.23
|
| Rate for Payer: BCBS MAPPO |
$134.52
|
| Rate for Payer: BCBS Trust/PPO |
$442.36
|
| Rate for Payer: BCN Commercial |
$418.36
|
| Rate for Payer: BCN Medicare Advantage |
$134.52
|
| Rate for Payer: Cash Price |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$462.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.52
|
| Rate for Payer: Healthscope Commercial |
$484.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.37
|
| Rate for Payer: Nomi Health Commercial |
$441.23
|
| Rate for Payer: PACE Senior Care Partners |
$127.79
|
| Rate for Payer: PACE SWMI |
$134.52
|
| Rate for Payer: PHP Commercial |
$457.37
|
| Rate for Payer: PHP Medicare Advantage |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.75
|
| Rate for Payer: Priority Health HMO/PPO |
$468.13
|
| Rate for Payer: Priority Health Medicare |
$135.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.51
|
| Rate for Payer: Railroad Medicare Medicare |
$134.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.51
|
| Rate for Payer: UHC Core |
$449.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.52
|
| Rate for Payer: UHC Exchange |
$134.52
|
| Rate for Payer: UHC Medicare Advantage |
$134.52
|
| Rate for Payer: VA VA |
$134.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.56
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$538.08
|
|
|
Service Code
|
NDC 60687063401
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$484.27 |
| Rate for Payer: Aetna Commercial |
$457.37
|
| Rate for Payer: BCBS Trust/PPO |
$439.23
|
| Rate for Payer: BCN Commercial |
$415.83
|
| Rate for Payer: Cash Price |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$462.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.46
|
| Rate for Payer: Healthscope Commercial |
$484.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.37
|
| Rate for Payer: Nomi Health Commercial |
$441.23
|
| Rate for Payer: PHP Commercial |
$457.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.75
|
| Rate for Payer: Priority Health HMO/PPO |
$468.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.51
|
| Rate for Payer: UHC Core |
$449.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.56
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$3,078.59
|
|
|
Service Code
|
NDC 00078035934
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,001.08 |
| Max. Negotiated Rate |
$2,770.73 |
| Rate for Payer: Aetna Commercial |
$2,616.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,513.05
|
| Rate for Payer: BCN Commercial |
$2,379.13
|
| Rate for Payer: Cash Price |
$2,462.87
|
| Rate for Payer: Cofinity Commercial |
$2,647.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,462.87
|
| Rate for Payer: Healthscope Commercial |
$2,770.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,308.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,616.80
|
| Rate for Payer: Nomi Health Commercial |
$2,524.44
|
| Rate for Payer: PHP Commercial |
$2,616.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,001.08
|
| Rate for Payer: Priority Health HMO/PPO |
$2,678.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,062.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,709.16
|
| Rate for Payer: UHC Core |
$2,570.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,308.94
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$233.42
|
|
|
Service Code
|
NDC 65862057290
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Aetna Commercial |
$198.41
|
| Rate for Payer: BCBS Trust/PPO |
$190.54
|
| Rate for Payer: BCN Commercial |
$180.39
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Commercial |
$200.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Healthscope Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.41
|
| Rate for Payer: Nomi Health Commercial |
$191.40
|
| Rate for Payer: PHP Commercial |
$198.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.72
|
| Rate for Payer: Priority Health HMO/PPO |
$203.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.41
|
| Rate for Payer: UHC Core |
$194.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
IP
|
$5.39
|
|
|
Service Code
|
NDC 60687063411
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$4.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.58
|
| Rate for Payer: Nomi Health Commercial |
$4.42
|
| Rate for Payer: PHP Commercial |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$5.39
|
|
|
Service Code
|
NDC 60687063411
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.68
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.43
|
| Rate for Payer: BCN Commercial |
$4.19
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cofinity Commercial |
$4.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$4.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.58
|
| Rate for Payer: Nomi Health Commercial |
$4.42
|
| Rate for Payer: PACE Senior Care Partners |
$1.28
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$4.58
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4.69
|
| Rate for Payer: Priority Health Medicare |
$1.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
| Rate for Payer: VA VA |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.04
|
|
|
VALSARTAN 160 MG TABLET
|
Facility
|
OP
|
$233.42
|
|
|
Service Code
|
NDC 65862057290
|
| Hospital Charge Code |
31210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Aetna Commercial |
$198.41
|
| Rate for Payer: Aetna Medicare |
$60.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.94
|
| Rate for Payer: BCBS Complete |
$93.37
|
| Rate for Payer: BCBS MAPPO |
$58.35
|
| Rate for Payer: BCBS Trust/PPO |
$191.89
|
| Rate for Payer: BCN Commercial |
$181.48
|
| Rate for Payer: BCN Medicare Advantage |
$58.35
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Commercial |
$200.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.35
|
| Rate for Payer: Healthscope Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.41
|
| Rate for Payer: Nomi Health Commercial |
$191.40
|
| Rate for Payer: PACE Senior Care Partners |
$55.44
|
| Rate for Payer: PACE SWMI |
$58.35
|
| Rate for Payer: PHP Commercial |
$198.41
|
| Rate for Payer: PHP Medicare Advantage |
$58.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.72
|
| Rate for Payer: Priority Health HMO/PPO |
$203.08
|
| Rate for Payer: Priority Health Medicare |
$58.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.39
|
| Rate for Payer: Railroad Medicare Medicare |
$58.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.41
|
| Rate for Payer: UHC Core |
$194.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.35
|
| Rate for Payer: UHC Exchange |
$58.35
|
| Rate for Payer: UHC Medicare Advantage |
$58.35
|
| Rate for Payer: VA VA |
$58.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$111.46
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Medicare |
$28.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: BCBS Complete |
$44.58
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCBS Trust/PPO |
$91.63
|
| Rate for Payer: BCN Commercial |
$86.66
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: Cofinity Commercial |
$95.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Healthscope Commercial |
$100.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.74
|
| Rate for Payer: Nomi Health Commercial |
$91.40
|
| Rate for Payer: PACE Senior Care Partners |
$26.47
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PHP Commercial |
$94.74
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health HMO/PPO |
$96.97
|
| Rate for Payer: Priority Health Medicare |
$28.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.68
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.08
|
| Rate for Payer: UHC Core |
$93.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Exchange |
$27.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: VA VA |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.59
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$70.68
|
|
|
Service Code
|
NDC 00378580793
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: BCBS Trust/PPO |
$57.70
|
| Rate for Payer: BCN Commercial |
$54.62
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.94
|
| Rate for Payer: Priority Health HMO/PPO |
$61.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
