|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$13,949.11
|
|
|
Service Code
|
MS-DRG 798
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$13,949.11 |
| Rate for Payer: Aetna Medicare |
$7,225.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,684.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,684.58
|
| Rate for Payer: BCBS MAPPO |
$6,947.66
|
| Rate for Payer: BCBS Trust/PPO |
$13,949.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,947.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,947.66
|
| Rate for Payer: Mclaren Medicare |
$6,947.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,295.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,989.81
|
| Rate for Payer: PACE Medicare |
$6,600.28
|
| Rate for Payer: PACE SWMI |
$6,947.66
|
| Rate for Payer: PHP Medicare Advantage |
$6,947.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,640.66
|
| Rate for Payer: Priority Health Medicare |
$6,947.66
|
| Rate for Payer: Priority Health Narrow Network |
$9,312.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,947.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,374.04
|
| Rate for Payer: UHC Core |
$10,146.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,947.66
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,156.09
|
| Rate for Payer: VA VA |
$6,947.66
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.76 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,661.05
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$828.76
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$915.53 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,423.93
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.08
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$915.53
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$882.46 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,393.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.71
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$882.46
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 58291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,224.96 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,393.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.46
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$1,224.96
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
IP
|
$84.82
|
|
|
Service Code
|
NDC 0378-4276-93
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna American Axle |
$55.13
|
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.13
|
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Cofinity Commercial |
$59.37
|
| Rate for Payer: Cofinity Commercial |
$72.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.86
|
| Rate for Payer: Healthscope Commercial |
$76.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.10
|
| Rate for Payer: PHP Commercial |
$72.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.37
|
| Rate for Payer: Priority Health SBD |
$53.44
|
| Rate for Payer: UMR Bronson Commercial |
$37.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.62
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
IP
|
$127.40
|
|
|
Service Code
|
NDC 57237-043-30
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$114.66 |
| Rate for Payer: Aetna American Axle |
$82.81
|
| Rate for Payer: Aetna Commercial |
$108.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.81
|
| Rate for Payer: Cash Price |
$101.92
|
| Rate for Payer: Cofinity Commercial |
$109.56
|
| Rate for Payer: Cofinity Commercial |
$89.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.92
|
| Rate for Payer: Healthscope Commercial |
$114.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.29
|
| Rate for Payer: PHP Commercial |
$108.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.18
|
| Rate for Payer: Priority Health SBD |
$80.26
|
| Rate for Payer: UMR Bronson Commercial |
$56.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.55
|
|
|
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
|
$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
|
$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
|
$218.88
|
|
|
Service Code
|
NDC 0378-4275-77
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$196.99 |
| Rate for Payer: Aetna American Axle |
$142.27
|
| Rate for Payer: Aetna Commercial |
$186.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.27
|
| Rate for Payer: Cash Price |
$175.10
|
| Rate for Payer: Cofinity Commercial |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$188.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.10
|
| Rate for Payer: Healthscope Commercial |
$196.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.05
|
| Rate for Payer: PHP Commercial |
$186.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.22
|
| Rate for Payer: Priority Health SBD |
$137.89
|
| Rate for Payer: UMR Bronson Commercial |
$96.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.16
|
|
|
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
|
|
|
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
|
|
|
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
|
$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
|
|
|
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 |
$2,094.25
|
| Rate for Payer: Cofinity Commercial |
$1,704.62
|
| 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
|
|
|
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
|
$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
|
$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
|
$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
|
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
|
|
|
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 |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| 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
|
|
