|
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
|
$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
|
$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
|
$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 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 |
$270.66
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| 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 (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 68094-193-61
|
| 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
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 68094-193-59
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
|
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
|
$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
|
|
|
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
|
$1.77
|
|
|
Service Code
|
NDC 9900-0019-51
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna American Axle |
$1.15
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$8.43
|
|
|
Service Code
|
NDC 0121-4675-40
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna American Axle |
$5.48
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.48
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.90
|
| Rate for Payer: Priority Health SBD |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.32
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$222.31
|
|
|
Service Code
|
NDC 0121-0675-85
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$200.08 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.85
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Cofinity Commercial |
$191.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.85
|
| Rate for Payer: Healthscope Commercial |
$200.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.62
|
| Rate for Payer: Priority Health SBD |
$140.06
|
| Rate for Payer: UMR Bronson Commercial |
$97.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.73
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$144.51
|
|
|
Service Code
|
NDC 50383-792-16
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$130.06 |
| Rate for Payer: Aetna American Axle |
$93.93
|
| Rate for Payer: Aetna Commercial |
$122.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.93
|
| Rate for Payer: Cash Price |
$115.61
|
| Rate for Payer: Cofinity Commercial |
$101.16
|
| Rate for Payer: Cofinity Commercial |
$124.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.61
|
| Rate for Payer: Healthscope Commercial |
$130.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.83
|
| Rate for Payer: PHP Commercial |
$122.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.16
|
| Rate for Payer: Priority Health SBD |
$91.04
|
| Rate for Payer: UMR Bronson Commercial |
$63.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.38
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$300.12
|
|
|
Service Code
|
NDC 60432-621-16
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.05 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Aetna American Axle |
$195.08
|
| Rate for Payer: Aetna Commercial |
$255.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.08
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cofinity Commercial |
$210.08
|
| Rate for Payer: Cofinity Commercial |
$258.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.10
|
| Rate for Payer: Healthscope Commercial |
$270.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.10
|
| Rate for Payer: PHP Commercial |
$255.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.08
|
| Rate for Payer: Priority Health SBD |
$189.08
|
| Rate for Payer: UMR Bronson Commercial |
$132.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
IP
|
$7,103.64
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,125.60 |
| Max. Negotiated Rate |
$6,393.28 |
| Rate for Payer: Aetna American Axle |
$4,617.37
|
| Rate for Payer: Aetna American Axle |
$3,244.34
|
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Commercial |
$6,038.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,244.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,617.37
|
| Rate for Payer: Cash Price |
$5,682.91
|
| Rate for Payer: Cash Price |
$3,993.03
|
| Rate for Payer: Cofinity Commercial |
$3,493.90
|
| Rate for Payer: Cofinity Commercial |
$6,109.13
|
| Rate for Payer: Cofinity Commercial |
$4,972.55
|
| Rate for Payer: Cofinity Commercial |
$4,292.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,993.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,682.91
|
| Rate for Payer: Healthscope Commercial |
$6,393.28
|
| Rate for Payer: Healthscope Commercial |
$4,492.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,493.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,972.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,743.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,242.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,038.09
|
| Rate for Payer: PHP Commercial |
$4,242.60
|
| Rate for Payer: PHP Commercial |
$6,038.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,972.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,493.90
|
| Rate for Payer: Priority Health SBD |
$3,144.51
|
| Rate for Payer: Priority Health SBD |
$4,475.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,196.17
|
| Rate for Payer: UMR Bronson Commercial |
$3,125.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,743.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,327.73
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
OP
|
$4,991.29
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$746.02 |
| Max. Negotiated Rate |
$4,492.16 |
| Rate for Payer: Aetna American Axle |
$3,244.34
|
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Medicare |
$1,418.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,244.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,704.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,704.81
|
| Rate for Payer: BCBS Complete |
$783.39
|
| Rate for Payer: BCBS MAPPO |
$1,363.85
|
| Rate for Payer: BCBS Trust/PPO |
$4,407.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.85
|
| Rate for Payer: Cash Price |
$3,993.03
|
| Rate for Payer: Cash Price |
$3,993.03
|
| Rate for Payer: Cofinity Commercial |
$3,493.90
|
| Rate for Payer: Cofinity Commercial |
$4,292.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,993.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.85
|
| Rate for Payer: Healthscope Commercial |
$4,492.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,493.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,743.47
|
| Rate for Payer: Mclaren Medicaid |
$746.02
|
| Rate for Payer: Mclaren Medicare |
$1,363.85
|
| Rate for Payer: Meridian Medicaid |
$783.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,432.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,568.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,242.60
|
| Rate for Payer: PACE Medicare |
$1,295.66
|
| Rate for Payer: PACE SWMI |
$1,363.85
|
| Rate for Payer: PHP Commercial |
$4,242.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,493.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,189.90
|
| Rate for Payer: Priority Health Medicare |
$1,363.85
|
| Rate for Payer: Priority Health Narrow Network |
$3,351.92
|
| Rate for Payer: Priority Health SBD |
$3,144.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,363.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,363.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,846.78
|
| Rate for Payer: VA VA |
$1,363.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,743.47
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$257.36
|
|
|
Service Code
|
NDC 59746-363-90
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.24 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna American Axle |
$167.28
|
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.76
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.15
|
| Rate for Payer: Priority Health SBD |
$162.14
|
| Rate for Payer: UMR Bronson Commercial |
$113.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.02
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$223.35
|
|
|
Service Code
|
NDC 0378-5815-77
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$201.02 |
| Rate for Payer: Aetna American Axle |
$145.18
|
| Rate for Payer: Aetna Commercial |
$189.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.18
|
| Rate for Payer: Cash Price |
$178.68
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.68
|
| Rate for Payer: Healthscope Commercial |
$201.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.85
|
| Rate for Payer: PHP Commercial |
$189.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.34
|
| Rate for Payer: Priority Health SBD |
$140.71
|
| Rate for Payer: UMR Bronson Commercial |
$98.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.51
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$3,818.18
|
|
|
Service Code
|
NDC 0078-0360-34
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$3,436.36 |
| Rate for Payer: Aetna American Axle |
$2,481.82
|
| Rate for Payer: Aetna Commercial |
$3,245.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,481.82
|
| Rate for Payer: Cash Price |
$3,054.54
|
| Rate for Payer: Cofinity Commercial |
$2,672.73
|
| Rate for Payer: Cofinity Commercial |
$3,283.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,054.54
|
| Rate for Payer: Healthscope Commercial |
$3,436.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,672.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,863.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,245.45
|
| Rate for Payer: PHP Commercial |
$3,245.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,672.73
|
| Rate for Payer: Priority Health SBD |
$2,405.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,680.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,863.64
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$247.10
|
|
|
Service Code
|
NDC 72819-184-09
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$222.39 |
| Rate for Payer: Aetna American Axle |
$160.62
|
| Rate for Payer: Aetna Commercial |
$210.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.62
|
| Rate for Payer: Cash Price |
$197.68
|
| Rate for Payer: Cofinity Commercial |
$172.97
|
| Rate for Payer: Cofinity Commercial |
$212.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.68
|
| Rate for Payer: Healthscope Commercial |
$222.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.04
|
| Rate for Payer: PHP Commercial |
$210.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.97
|
| Rate for Payer: Priority Health SBD |
$155.67
|
| Rate for Payer: UMR Bronson Commercial |
$108.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.32
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$216.87
|
|
|
Service Code
|
NDC 51660-143-90
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$195.18 |
| Rate for Payer: Aetna American Axle |
$140.97
|
| Rate for Payer: Aetna Commercial |
$184.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.97
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cofinity Commercial |
$151.81
|
| Rate for Payer: Cofinity Commercial |
$186.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.50
|
| Rate for Payer: Healthscope Commercial |
$195.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.34
|
| Rate for Payer: PHP Commercial |
$184.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.81
|
| Rate for Payer: Priority Health SBD |
$136.63
|
| Rate for Payer: UMR Bronson Commercial |
$95.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.65
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
NDC 60687-612-21
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna American Axle |
$72.54
|
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.54
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.86
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.12
|
| Rate for Payer: Priority Health SBD |
$70.31
|
| Rate for Payer: UMR Bronson Commercial |
$49.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$782.67
|
|
|
Service Code
|
NDC 0078-0423-15
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.37 |
| Max. Negotiated Rate |
$704.40 |
| Rate for Payer: Aetna American Axle |
$508.74
|
| Rate for Payer: Aetna Commercial |
$665.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.74
|
| Rate for Payer: Cash Price |
$626.14
|
| Rate for Payer: Cofinity Commercial |
$547.87
|
| Rate for Payer: Cofinity Commercial |
$673.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.14
|
| Rate for Payer: Healthscope Commercial |
$704.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$587.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$665.27
|
| Rate for Payer: PHP Commercial |
$665.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.87
|
| Rate for Payer: Priority Health SBD |
$493.08
|
| Rate for Payer: UMR Bronson Commercial |
$344.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$587.00
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 60687-612-11
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
