|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$309.51
|
|
|
Service Code
|
NDC 57237-042-90
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$278.56 |
| Rate for Payer: Aetna American Axle |
$201.18
|
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.18
|
| Rate for Payer: Cash Price |
$247.61
|
| Rate for Payer: Cofinity Commercial |
$216.66
|
| Rate for Payer: Cofinity Commercial |
$266.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.61
|
| Rate for Payer: Healthscope Commercial |
$278.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.08
|
| Rate for Payer: PHP Commercial |
$263.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.66
|
| Rate for Payer: Priority Health SBD |
$194.99
|
| Rate for Payer: UMR Bronson Commercial |
$136.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.13
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$4,401.89
|
|
|
Service Code
|
NDC 0173-0933-56
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,936.83 |
| Max. Negotiated Rate |
$3,961.70 |
| Rate for Payer: Aetna American Axle |
$2,861.23
|
| Rate for Payer: Aetna Commercial |
$3,741.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,861.23
|
| Rate for Payer: Cash Price |
$3,521.51
|
| Rate for Payer: Cofinity Commercial |
$3,081.32
|
| Rate for Payer: Cofinity Commercial |
$3,785.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,521.51
|
| Rate for Payer: Healthscope Commercial |
$3,961.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,081.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,301.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,741.61
|
| Rate for Payer: PHP Commercial |
$3,741.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,081.32
|
| Rate for Payer: Priority Health SBD |
$2,773.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,936.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,301.42
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$73.53
|
|
|
Service Code
|
NDC 57237-042-30
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$66.18 |
| Rate for Payer: Aetna American Axle |
$47.79
|
| Rate for Payer: Aetna Commercial |
$62.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.79
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Cofinity Commercial |
$63.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.82
|
| Rate for Payer: Healthscope Commercial |
$66.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.50
|
| Rate for Payer: PHP Commercial |
$62.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.47
|
| Rate for Payer: Priority Health SBD |
$46.32
|
| Rate for Payer: UMR Bronson Commercial |
$32.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.15
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$487.20
|
|
|
Service Code
|
NDC 0904-6565-61
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$438.48 |
| Rate for Payer: Aetna American Axle |
$316.68
|
| Rate for Payer: Aetna Commercial |
$414.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.68
|
| Rate for Payer: Cash Price |
$389.76
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$438.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.12
|
| Rate for Payer: PHP Commercial |
$414.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.04
|
| Rate for Payer: Priority Health SBD |
$306.94
|
| Rate for Payer: UMR Bronson Commercial |
$214.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.40
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$1,372.19
|
|
|
Service Code
|
NDC 0173-0933-08
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$603.76 |
| Max. Negotiated Rate |
$1,234.97 |
| Rate for Payer: Aetna American Axle |
$891.92
|
| Rate for Payer: Aetna Commercial |
$1,166.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.92
|
| Rate for Payer: Cash Price |
$1,097.75
|
| Rate for Payer: Cofinity Commercial |
$1,180.08
|
| Rate for Payer: Cofinity Commercial |
$960.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.75
|
| Rate for Payer: Healthscope Commercial |
$1,234.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.36
|
| Rate for Payer: PHP Commercial |
$1,166.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.53
|
| Rate for Payer: Priority Health SBD |
$864.48
|
| Rate for Payer: UMR Bronson Commercial |
$603.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.14
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$327.03
|
|
|
Service Code
|
NDC 65862-448-90
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.89 |
| Max. Negotiated Rate |
$294.33 |
| Rate for Payer: Aetna American Axle |
$212.57
|
| Rate for Payer: Aetna Commercial |
$277.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.57
|
| Rate for Payer: Cash Price |
$261.62
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.62
|
| Rate for Payer: Healthscope Commercial |
$294.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.98
|
| Rate for Payer: PHP Commercial |
$277.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.92
|
| Rate for Payer: Priority Health SBD |
$206.03
|
| Rate for Payer: UMR Bronson Commercial |
$143.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.27
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$469.09
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$422.18 |
| Rate for Payer: Aetna American Axle |
$304.91
|
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.91
|
| Rate for Payer: Cash Price |
$375.27
|
| Rate for Payer: Cofinity Commercial |
$328.36
|
| Rate for Payer: Cofinity Commercial |
$403.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.27
|
| Rate for Payer: Healthscope Commercial |
$422.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.73
|
| Rate for Payer: PHP Commercial |
$398.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.36
|
| Rate for Payer: Priority Health SBD |
$295.53
|
| Rate for Payer: UMR Bronson Commercial |
$206.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.82
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$18,251.51
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,030.66 |
| Max. Negotiated Rate |
$16,426.36 |
| Rate for Payer: Aetna American Axle |
$11,863.48
|
| Rate for Payer: Aetna Commercial |
$15,513.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,863.48
|
| Rate for Payer: Cash Price |
$14,601.21
|
| Rate for Payer: Cofinity Commercial |
$12,776.06
|
| Rate for Payer: Cofinity Commercial |
$15,696.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,601.21
|
| Rate for Payer: Healthscope Commercial |
$16,426.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,776.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,688.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,513.78
|
| Rate for Payer: PHP Commercial |
$15,513.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,776.06
|
| Rate for Payer: Priority Health SBD |
$11,498.45
|
| Rate for Payer: UMR Bronson Commercial |
$8,030.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,688.63
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$2,435.17
|
|
|
Service Code
|
NDC 72205-019-01
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,071.47 |
| Max. Negotiated Rate |
$2,191.65 |
| Rate for Payer: Aetna American Axle |
$1,582.86
|
| Rate for Payer: Aetna Commercial |
$2,069.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.86
|
| Rate for Payer: Cash Price |
$1,948.14
|
| Rate for Payer: Cofinity Commercial |
$1,704.62
|
| Rate for Payer: Cofinity Commercial |
$2,094.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.14
|
| Rate for Payer: Healthscope Commercial |
$2,191.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,704.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,826.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,069.89
|
| Rate for Payer: PHP Commercial |
$2,069.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.62
|
| Rate for Payer: Priority Health SBD |
$1,534.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,071.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,826.38
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
IP
|
$3,682.54
|
|
|
Service Code
|
NDC 0004-0039-09
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,620.32 |
| Max. Negotiated Rate |
$3,314.29 |
| Rate for Payer: Aetna American Axle |
$2,393.65
|
| Rate for Payer: Aetna Commercial |
$3,130.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.65
|
| Rate for Payer: Cash Price |
$2,946.03
|
| Rate for Payer: Cofinity Commercial |
$2,577.78
|
| Rate for Payer: Cofinity Commercial |
$3,166.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.03
|
| Rate for Payer: Healthscope Commercial |
$3,314.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,577.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,761.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,130.16
|
| Rate for Payer: PHP Commercial |
$3,130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,577.78
|
| Rate for Payer: Priority Health SBD |
$2,320.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,620.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,761.90
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
|
Service Code
|
NDC 0143-9637-01
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
OP
|
$29.82
|
|
|
Service Code
|
NDC 63323-494-05
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.87
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
|
Service Code
|
NDC 0143-9785-10
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$29.82
|
|
|
Service Code
|
NDC 63323-494-05
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.87
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
|
Service Code
|
NDC 0143-9785-01
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$29.82
|
|
|
Service Code
|
NDC 63323-494-01
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.87
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$16.17
|
|
|
Service Code
|
NDC 0143-9637-10
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$250.80
|
|
|
Service Code
|
NDC 63739-086-10
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.18
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.56
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$386.65
|
|
|
Service Code
|
NDC 0832-0310-11
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$347.98 |
| Rate for Payer: Aetna American Axle |
$251.32
|
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.32
|
| Rate for Payer: Cash Price |
$309.32
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.32
|
| Rate for Payer: Healthscope Commercial |
$347.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.65
|
| Rate for Payer: PHP Commercial |
$328.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.66
|
| Rate for Payer: Priority Health SBD |
$243.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.99
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$352.50
|
|
|
Service Code
|
NDC 69452-150-20
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$319.20
|
|
|
Service Code
|
NDC 71930-057-12
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.44
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
IP
|
$353.40
|
|
|
Service Code
|
NDC 0591-4012-01
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.39
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.38
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UMR Bronson Commercial |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$5.57
|
|
|
Service Code
|
NDC 0121-4675-05
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$5.57
|
|
|
Service Code
|
NDC 0121-4675-00
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$4.33
|
|
|
Service Code
|
NDC 68094-193-62
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.68
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
