|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,556.89
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$3,556.89 |
| Rate for Payer: BCBS Complete |
$3,556.89
|
| Rate for Payer: Mclaren Medicaid |
$3,387.51
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,387.51
|
| Rate for Payer: UHC Medicaid |
$3,387.51
|
| Rate for Payer: UHCCP Medicaid |
$3,387.51
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$4,578.68
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$4,578.68 |
| Rate for Payer: BCBS Complete |
$4,578.68
|
| Rate for Payer: Mclaren Medicaid |
$4,360.65
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,360.65
|
| Rate for Payer: UHC Medicaid |
$4,360.65
|
| Rate for Payer: UHCCP Medicaid |
$4,360.65
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$16,983.93
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$6,793.22 |
| Max. Negotiated Rate |
$16,983.93 |
| Rate for Payer: Aetna Medicare |
$9,317.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,198.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,198.74
|
| Rate for Payer: BCBS MAPPO |
$8,958.99
|
| Rate for Payer: BCBS Trust/PPO |
$16,983.93
|
| Rate for Payer: BCN Commercial |
$16,983.93
|
| Rate for Payer: BCN Medicare Advantage |
$8,958.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,958.99
|
| Rate for Payer: Mclaren Medicare |
$8,958.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,406.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,302.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,854.89
|
| Rate for Payer: Nomi Health Commercial |
$12,905.16
|
| Rate for Payer: PACE Medicare |
$8,511.04
|
| Rate for Payer: PACE SWMI |
$8,958.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,958.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,491.53
|
| Rate for Payer: Priority Health Medicare |
$8,958.99
|
| Rate for Payer: Priority Health Tiered Network |
$6,793.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8,958.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,306.52
|
| Rate for Payer: UHC Core |
$13,642.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,958.99
|
| Rate for Payer: UHC Exchange |
$11,141.45
|
| Rate for Payer: VA VA |
$8,958.99
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$20,511.39
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$9,834.62 |
| Max. Negotiated Rate |
$20,511.39 |
| Rate for Payer: Aetna Medicare |
$10,766.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,940.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,940.29
|
| Rate for Payer: BCBS MAPPO |
$10,352.23
|
| Rate for Payer: BCBS Trust/PPO |
$20,511.39
|
| Rate for Payer: BCN Commercial |
$20,511.39
|
| Rate for Payer: BCN Medicare Advantage |
$10,352.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,352.23
|
| Rate for Payer: Mclaren Medicare |
$10,352.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,869.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,905.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,387.45
|
| Rate for Payer: Nomi Health Commercial |
$15,054.30
|
| Rate for Payer: PACE Medicare |
$9,834.62
|
| Rate for Payer: PACE SWMI |
$10,352.23
|
| Rate for Payer: PHP Medicare Advantage |
$10,352.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,721.13
|
| Rate for Payer: Priority Health Medicare |
$10,352.23
|
| Rate for Payer: Priority Health Tiered Network |
$11,776.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10,352.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,022.10
|
| Rate for Payer: UHC Core |
$15,914.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,352.23
|
| Rate for Payer: UHC Exchange |
$12,996.88
|
| Rate for Payer: VA VA |
$10,352.23
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$15,600.73
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$6,793.22 |
| Max. Negotiated Rate |
$15,600.73 |
| Rate for Payer: Aetna Medicare |
$8,940.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,746.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,746.11
|
| Rate for Payer: BCBS MAPPO |
$8,596.89
|
| Rate for Payer: BCBS Trust/PPO |
$15,238.05
|
| Rate for Payer: BCN Commercial |
$15,238.05
|
| Rate for Payer: BCN Medicare Advantage |
$8,596.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,596.89
|
| Rate for Payer: Mclaren Medicare |
$8,596.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,026.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,886.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,456.58
|
| Rate for Payer: Nomi Health Commercial |
$12,346.59
|
| Rate for Payer: PACE Medicare |
$8,167.05
|
| Rate for Payer: PACE SWMI |
$8,596.89
|
| Rate for Payer: PHP Medicare Advantage |
$8,596.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,491.53
|
| Rate for Payer: Priority Health Medicare |
$8,596.89
|
| Rate for Payer: Priority Health Tiered Network |
$6,793.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8,596.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,600.73
|
| Rate for Payer: UHC Core |
$13,051.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,596.89
|
| Rate for Payer: UHC Exchange |
$10,659.22
|
| Rate for Payer: VA VA |
$8,596.89
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,905.86
|
| Rate for Payer: BCN Commercial |
$5,905.86
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,139.54
|
| Rate for Payer: BCN Commercial |
$8,139.54
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
OP
|
$84.82
|
|
|
Service Code
|
NDC 57237004330
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna American Axle |
$55.13
|
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: Aetna Medicare |
$42.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.13
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.62
|
| Rate for Payer: PHP Commercial |
$72.10
|
| Rate for Payer: Priority Health SBD |
$53.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.13
|
| Rate for Payer: UHC Core |
$44.19
|
| Rate for Payer: UHC Exchange |
$33.33
|
| Rate for Payer: UMR Bronson Commercial |
$31.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.62
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
OP
|
$141.93
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$127.74 |
| Rate for Payer: Aetna American Axle |
$92.25
|
| Rate for Payer: Aetna Commercial |
$120.64
|
| Rate for Payer: Aetna Medicare |
$70.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.25
|
| Rate for Payer: BCBS Complete |
$56.77
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Advantage |
$99.35
|
| Rate for Payer: Cofinity Commercial |
$122.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$127.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.45
|
| Rate for Payer: PHP Commercial |
$120.64
|
| Rate for Payer: Priority Health SBD |
$89.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.25
|
| Rate for Payer: UHC Core |
$73.95
|
| Rate for Payer: UHC Exchange |
$55.78
|
| Rate for Payer: UMR Bronson Commercial |
$52.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.45
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
IP
|
$84.82
|
|
|
Service Code
|
NDC 57237004330
|
| 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 Advantage |
$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 Commercial |
$72.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.62
|
| Rate for Payer: PHP Commercial |
$72.10
|
| 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
|
$141.93
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$127.74 |
| Rate for Payer: Aetna American Axle |
$92.25
|
| Rate for Payer: Aetna Commercial |
$120.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.25
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Advantage |
$99.35
|
| Rate for Payer: Cofinity Commercial |
$122.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$127.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.45
|
| Rate for Payer: PHP Commercial |
$120.64
|
| Rate for Payer: Priority Health SBD |
$89.42
|
| Rate for Payer: UMR Bronson Commercial |
$62.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.45
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$309.51
|
|
|
Service Code
|
NDC 57237004290
|
| 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 Advantage |
$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 Commercial |
$263.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.13
|
| Rate for Payer: PHP Commercial |
$263.08
|
| 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
|
$106.02
|
|
|
Service Code
|
NDC 57237004230
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna American Axle |
$68.91
|
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.91
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Advantage |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.82
|
| Rate for Payer: Healthscope Commercial |
$95.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health SBD |
$66.79
|
| Rate for Payer: UMR Bronson Commercial |
$46.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$327.03
|
|
|
Service Code
|
NDC 65862044890
|
| 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 Advantage |
$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 Commercial |
$277.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.27
|
| Rate for Payer: PHP Commercial |
$277.98
|
| 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
|
$1,372.19
|
|
|
Service Code
|
NDC 00173093308
|
| 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 Advantage |
$960.53
|
| Rate for Payer: Cofinity Commercial |
$1,180.08
|
| 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 Commercial |
$1,166.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.14
|
| Rate for Payer: PHP Commercial |
$1,166.36
|
| 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
|
$222.30
|
|
|
Service Code
|
NDC 00378427577
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| 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 |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00378427577
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.50
|
| Rate for Payer: UHC Core |
$115.82
|
| Rate for Payer: UHC Exchange |
$87.36
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$1,372.19
|
|
|
Service Code
|
NDC 00173093308
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.71 |
| 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 Medicare |
$686.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.92
|
| Rate for Payer: BCBS Complete |
$548.88
|
| Rate for Payer: Cash Price |
$1,097.75
|
| Rate for Payer: Cofinity Advantage |
$960.53
|
| Rate for Payer: Cofinity Commercial |
$1,180.08
|
| 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: MI Amish Medical Board Commercial |
$1,097.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.14
|
| Rate for Payer: PHP Commercial |
$1,166.36
|
| Rate for Payer: Priority Health SBD |
$864.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.92
|
| Rate for Payer: UHC Core |
$714.91
|
| Rate for Payer: UHC Exchange |
$539.27
|
| Rate for Payer: UMR Bronson Commercial |
$507.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.14
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$106.02
|
|
|
Service Code
|
NDC 57237004230
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna American Axle |
$68.91
|
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: Aetna Medicare |
$53.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.91
|
| Rate for Payer: BCBS Complete |
$42.41
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Advantage |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.82
|
| Rate for Payer: Healthscope Commercial |
$95.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health SBD |
$66.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.91
|
| Rate for Payer: UHC Core |
$55.24
|
| Rate for Payer: UHC Exchange |
$41.67
|
| Rate for Payer: UMR Bronson Commercial |
$39.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$327.03
|
|
|
Service Code
|
NDC 65862044890
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$294.33 |
| Rate for Payer: Aetna American Axle |
$212.57
|
| Rate for Payer: Aetna Commercial |
$277.98
|
| Rate for Payer: Aetna Medicare |
$163.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.57
|
| Rate for Payer: BCBS Complete |
$130.81
|
| Rate for Payer: Cash Price |
$261.62
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$261.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.27
|
| Rate for Payer: PHP Commercial |
$277.98
|
| Rate for Payer: Priority Health SBD |
$206.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.57
|
| Rate for Payer: UHC Core |
$170.38
|
| Rate for Payer: UHC Exchange |
$128.52
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.27
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.88 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna American Axle |
$405.60
|
| Rate for Payer: Aetna Commercial |
$530.40
|
| Rate for Payer: Aetna Medicare |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.60
|
| Rate for Payer: BCBS Complete |
$249.60
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cofinity Advantage |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$536.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.20
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$436.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$499.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.00
|
| Rate for Payer: PHP Commercial |
$530.40
|
| Rate for Payer: Priority Health SBD |
$393.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.60
|
| Rate for Payer: UHC Core |
$325.10
|
| Rate for Payer: UHC Exchange |
$245.23
|
| Rate for Payer: UMR Bronson Commercial |
$230.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.00
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.56 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna American Axle |
$405.60
|
| Rate for Payer: Aetna Commercial |
$530.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.60
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cofinity Advantage |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$536.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.20
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$436.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.00
|
| Rate for Payer: PHP Commercial |
$530.40
|
| Rate for Payer: Priority Health SBD |
$393.12
|
| Rate for Payer: UMR Bronson Commercial |
$274.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.00
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$309.51
|
|
|
Service Code
|
NDC 57237004290
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$278.56 |
| Rate for Payer: Aetna American Axle |
$201.18
|
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Aetna Medicare |
$154.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.18
|
| Rate for Payer: BCBS Complete |
$123.80
|
| Rate for Payer: Cash Price |
$247.61
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.13
|
| Rate for Payer: PHP Commercial |
$263.08
|
| Rate for Payer: Priority Health SBD |
$194.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.18
|
| Rate for Payer: UHC Core |
$161.25
|
| Rate for Payer: UHC Exchange |
$121.64
|
| Rate for Payer: UMR Bronson Commercial |
$114.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.13
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$35.99
|
|
|
Service Code
|
NDC 50268078711
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$32.39 |
| Rate for Payer: Aetna American Axle |
$23.39
|
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.39
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: Cofinity Advantage |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$30.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.79
|
| Rate for Payer: Healthscope Commercial |
$32.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.99
|
| Rate for Payer: PHP Commercial |
$30.59
|
| Rate for Payer: Priority Health SBD |
$22.67
|
| Rate for Payer: UMR Bronson Commercial |
$15.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.99
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$18,251.51
|
|
|
Service Code
|
NDC 00004003822
|
| 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 Advantage |
$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 Commercial |
$15,513.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,688.63
|
| Rate for Payer: PHP Commercial |
$15,513.78
|
| 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
|
|
