|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.39
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna American Axle |
$4.15
|
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.15
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Advantage |
$4.47
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health SBD |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.39
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna American Axle |
$4.15
|
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.15
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Advantage |
$4.47
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health SBD |
$4.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.15
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: UHC Exchange |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
NDC 09900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna American Axle |
$1.15
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.33
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.15
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.70
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| 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
|
OP
|
$6.39
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna American Axle |
$4.15
|
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.15
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Advantage |
$4.47
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health SBD |
$4.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.15
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: UHC Exchange |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.39
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna American Axle |
$4.15
|
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.15
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Advantage |
$4.47
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$5.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: PHP Commercial |
$5.43
|
| Rate for Payer: Priority Health SBD |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.79
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 68094019359
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| 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 |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.89
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.50
|
| Rate for Payer: UHC Core |
$2.01
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| 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
|
OP
|
$8.03
|
|
|
Service Code
|
NDC 00121467540
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$7.23 |
| Rate for Payer: Aetna American Axle |
$5.22
|
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: Aetna Medicare |
$4.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.22
|
| Rate for Payer: BCBS Complete |
$3.21
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cofinity Advantage |
$5.62
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.42
|
| Rate for Payer: Healthscope Commercial |
$7.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.02
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: Priority Health SBD |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.22
|
| Rate for Payer: UHC Core |
$4.18
|
| Rate for Payer: UHC Exchange |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$2.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$355.70
|
|
|
Service Code
|
NDC 62559026616
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.61 |
| Max. Negotiated Rate |
$320.13 |
| Rate for Payer: Aetna American Axle |
$231.21
|
| Rate for Payer: Aetna Commercial |
$302.35
|
| Rate for Payer: Aetna Medicare |
$177.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: BCBS Complete |
$142.28
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Advantage |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$320.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.77
|
| Rate for Payer: PHP Commercial |
$302.35
|
| Rate for Payer: Priority Health SBD |
$224.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.21
|
| Rate for Payer: UHC Core |
$185.32
|
| Rate for Payer: UHC Exchange |
$139.79
|
| Rate for Payer: UMR Bronson Commercial |
$131.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.77
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$355.70
|
|
|
Service Code
|
NDC 00121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.61 |
| Max. Negotiated Rate |
$320.13 |
| Rate for Payer: Aetna American Axle |
$231.21
|
| Rate for Payer: Aetna Commercial |
$302.35
|
| Rate for Payer: Aetna Medicare |
$177.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: BCBS Complete |
$142.28
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Advantage |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$320.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.77
|
| Rate for Payer: PHP Commercial |
$302.35
|
| Rate for Payer: Priority Health SBD |
$224.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.21
|
| Rate for Payer: UHC Core |
$185.32
|
| Rate for Payer: UHC Exchange |
$139.79
|
| Rate for Payer: UMR Bronson Commercial |
$131.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.77
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$300.12
|
|
|
Service Code
|
NDC 60432062116
|
| 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 Advantage |
$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 Commercial |
$255.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.09
|
| Rate for Payer: PHP Commercial |
$255.10
|
| 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
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$144.51
|
|
|
Service Code
|
NDC 50383079216
|
| 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 Advantage |
$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 Commercial |
$122.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.38
|
| Rate for Payer: PHP Commercial |
$122.83
|
| 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
|
$355.70
|
|
|
Service Code
|
NDC 00121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$320.13 |
| Rate for Payer: Aetna American Axle |
$231.21
|
| Rate for Payer: Aetna Commercial |
$302.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Advantage |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$320.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.77
|
| Rate for Payer: PHP Commercial |
$302.35
|
| Rate for Payer: Priority Health SBD |
$224.09
|
| Rate for Payer: UMR Bronson Commercial |
$156.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.77
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$300.12
|
|
|
Service Code
|
NDC 60432062116
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Aetna American Axle |
$195.08
|
| Rate for Payer: Aetna Commercial |
$255.10
|
| Rate for Payer: Aetna Medicare |
$150.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.08
|
| Rate for Payer: BCBS Complete |
$120.05
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$240.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.09
|
| Rate for Payer: PHP Commercial |
$255.10
|
| Rate for Payer: Priority Health SBD |
$189.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.08
|
| Rate for Payer: UHC Core |
$156.36
|
| Rate for Payer: UHC Exchange |
$117.95
|
| Rate for Payer: UMR Bronson Commercial |
$111.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$144.51
|
|
|
Service Code
|
NDC 50383079216
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$130.06 |
| Rate for Payer: Aetna American Axle |
$93.93
|
| Rate for Payer: Aetna Commercial |
$122.83
|
| Rate for Payer: Aetna Medicare |
$72.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.93
|
| Rate for Payer: BCBS Complete |
$57.80
|
| Rate for Payer: Cash Price |
$115.61
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$115.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.38
|
| Rate for Payer: PHP Commercial |
$122.83
|
| Rate for Payer: Priority Health SBD |
$91.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.93
|
| Rate for Payer: UHC Core |
$75.29
|
| Rate for Payer: UHC Exchange |
$56.79
|
| Rate for Payer: UMR Bronson Commercial |
$53.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.38
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$355.70
|
|
|
Service Code
|
NDC 62559026616
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$320.13 |
| Rate for Payer: Aetna American Axle |
$231.21
|
| Rate for Payer: Aetna Commercial |
$302.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Advantage |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$320.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.77
|
| Rate for Payer: PHP Commercial |
$302.35
|
| Rate for Payer: Priority Health SBD |
$224.09
|
| Rate for Payer: UMR Bronson Commercial |
$156.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.77
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
IP
|
$4,881.25
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,147.75 |
| Max. Negotiated Rate |
$4,393.12 |
| Rate for Payer: Aetna American Axle |
$3,172.81
|
| Rate for Payer: Aetna American Axle |
$3,848.52
|
| Rate for Payer: Aetna Commercial |
$4,149.06
|
| Rate for Payer: Aetna Commercial |
$5,032.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,848.52
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cash Price |
$4,736.64
|
| Rate for Payer: Cofinity Advantage |
$4,144.56
|
| Rate for Payer: Cofinity Advantage |
$3,416.88
|
| Rate for Payer: Cofinity Commercial |
$5,091.89
|
| Rate for Payer: Cofinity Commercial |
$4,197.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,736.64
|
| Rate for Payer: Healthscope Commercial |
$4,393.12
|
| Rate for Payer: Healthscope Commercial |
$5,328.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,144.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,440.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,149.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,032.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,440.60
|
| Rate for Payer: PHP Commercial |
$4,149.06
|
| Rate for Payer: PHP Commercial |
$5,032.68
|
| Rate for Payer: Priority Health SBD |
$3,730.10
|
| Rate for Payer: Priority Health SBD |
$3,075.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,147.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,605.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,440.60
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
OP
|
$5,920.80
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$5,328.72 |
| Rate for Payer: Aetna American Axle |
$3,848.52
|
| Rate for Payer: Aetna American Axle |
$3,172.81
|
| Rate for Payer: Aetna Commercial |
$4,149.06
|
| Rate for Payer: Aetna Commercial |
$5,032.68
|
| Rate for Payer: Aetna Medicare |
$1,321.34
|
| Rate for Payer: Aetna Medicare |
$1,321.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,848.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,588.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,588.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,588.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,588.15
|
| Rate for Payer: BCBS Complete |
$697.77
|
| Rate for Payer: BCBS Complete |
$697.77
|
| Rate for Payer: BCBS MAPPO |
$1,270.52
|
| Rate for Payer: BCBS MAPPO |
$1,270.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,226.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,226.27
|
| Rate for Payer: BCN Commercial |
$4,226.27
|
| Rate for Payer: BCN Commercial |
$4,226.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,270.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,270.52
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cash Price |
$4,736.64
|
| Rate for Payer: Cash Price |
$4,736.64
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cofinity Advantage |
$4,144.56
|
| Rate for Payer: Cofinity Advantage |
$3,416.88
|
| Rate for Payer: Cofinity Commercial |
$4,197.88
|
| Rate for Payer: Cofinity Commercial |
$5,091.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,736.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,270.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,270.52
|
| Rate for Payer: Healthscope Commercial |
$4,393.12
|
| Rate for Payer: Healthscope Commercial |
$5,328.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,144.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,440.60
|
| Rate for Payer: Mclaren Medicaid |
$1,270.52
|
| Rate for Payer: Mclaren Medicaid |
$1,270.52
|
| Rate for Payer: Mclaren Medicare |
$1,270.52
|
| Rate for Payer: Mclaren Medicare |
$1,270.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,334.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,334.05
|
| Rate for Payer: Meridian Medicaid |
$1,334.05
|
| Rate for Payer: Meridian Medicaid |
$1,334.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,461.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,461.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,397.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,397.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,149.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,032.68
|
| Rate for Payer: Nomi Health Commercial |
$3,811.56
|
| Rate for Payer: Nomi Health Commercial |
$3,811.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,440.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.94
|
| Rate for Payer: PACE Medicare |
$1,206.99
|
| Rate for Payer: PACE Medicare |
$1,206.99
|
| Rate for Payer: PACE SWMI |
$1,270.52
|
| Rate for Payer: PACE SWMI |
$1,270.52
|
| Rate for Payer: PHP Commercial |
$4,149.06
|
| Rate for Payer: PHP Commercial |
$5,032.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,270.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,270.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,173.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,173.78
|
| Rate for Payer: Priority Health Medicare |
$1,270.52
|
| Rate for Payer: Priority Health Medicare |
$1,270.52
|
| Rate for Payer: Priority Health SBD |
$3,075.19
|
| Rate for Payer: Priority Health SBD |
$3,730.10
|
| Rate for Payer: Priority Health Tiered Network |
$3,339.02
|
| Rate for Payer: Priority Health Tiered Network |
$3,339.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,270.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,270.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,150.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,150.51
|
| Rate for Payer: UHC Core |
$2,150.51
|
| Rate for Payer: UHC Core |
$2,150.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,270.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,270.52
|
| Rate for Payer: UHC Exchange |
$2,150.51
|
| Rate for Payer: UHC Exchange |
$2,150.51
|
| Rate for Payer: UHC Medicaid |
$664.48
|
| Rate for Payer: UHC Medicaid |
$664.48
|
| Rate for Payer: UHCCP Medicaid |
$664.48
|
| Rate for Payer: UHCCP Medicaid |
$664.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,806.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,190.70
|
| Rate for Payer: VA VA |
$1,270.52
|
| Rate for Payer: VA VA |
$1,270.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,440.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.94
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$271.89
|
|
|
Service Code
|
NDC 43547037009
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$244.70 |
| Rate for Payer: Aetna American Axle |
$176.73
|
| Rate for Payer: Aetna Commercial |
$231.11
|
| Rate for Payer: Aetna Medicare |
$135.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.73
|
| Rate for Payer: BCBS Complete |
$108.76
|
| Rate for Payer: Cash Price |
$217.51
|
| Rate for Payer: Cofinity Advantage |
$190.32
|
| Rate for Payer: Cofinity Commercial |
$233.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.51
|
| Rate for Payer: Healthscope Commercial |
$244.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.92
|
| Rate for Payer: PHP Commercial |
$231.11
|
| Rate for Payer: Priority Health SBD |
$171.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.73
|
| Rate for Payer: UHC Core |
$141.65
|
| Rate for Payer: UHC Exchange |
$106.85
|
| Rate for Payer: UMR Bronson Commercial |
$100.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.92
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$216.87
|
|
|
Service Code
|
NDC 51660014390
|
| 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 Advantage |
$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 Commercial |
$184.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.65
|
| Rate for Payer: PHP Commercial |
$184.34
|
| 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 320 MG TABLET
|
Facility
|
OP
|
$247.10
|
|
|
Service Code
|
NDC 72819018409
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$222.39 |
| Rate for Payer: Aetna American Axle |
$160.62
|
| Rate for Payer: Aetna Commercial |
$210.03
|
| Rate for Payer: Aetna Medicare |
$123.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.62
|
| Rate for Payer: BCBS Complete |
$98.84
|
| Rate for Payer: Cash Price |
$197.68
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$197.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.32
|
| Rate for Payer: PHP Commercial |
$210.03
|
| Rate for Payer: Priority Health SBD |
$155.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.62
|
| Rate for Payer: UHC Core |
$128.74
|
| Rate for Payer: UHC Exchange |
$97.11
|
| Rate for Payer: UMR Bronson Commercial |
$91.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.32
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$4,111.89
|
|
|
Service Code
|
NDC 00078036034
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,809.23 |
| Max. Negotiated Rate |
$3,700.70 |
| Rate for Payer: Aetna American Axle |
$2,672.73
|
| Rate for Payer: Aetna Commercial |
$3,495.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,672.73
|
| Rate for Payer: Cash Price |
$3,289.51
|
| Rate for Payer: Cofinity Advantage |
$2,878.32
|
| Rate for Payer: Cofinity Commercial |
$3,536.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,289.51
|
| Rate for Payer: Healthscope Commercial |
$3,700.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,878.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,083.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,495.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,083.92
|
| Rate for Payer: PHP Commercial |
$3,495.11
|
| Rate for Payer: Priority Health SBD |
$2,590.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,809.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,083.92
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$223.35
|
|
|
Service Code
|
NDC 00378581577
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$201.01 |
| 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 Advantage |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.68
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| 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 Commercial |
$189.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.51
|
| Rate for Payer: PHP Commercial |
$189.85
|
| 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
|
OP
|
$223.35
|
|
|
Service Code
|
NDC 00378581577
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$201.01 |
| Rate for Payer: Aetna American Axle |
$145.18
|
| Rate for Payer: Aetna Commercial |
$189.85
|
| Rate for Payer: Aetna Medicare |
$111.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.18
|
| Rate for Payer: BCBS Complete |
$89.34
|
| Rate for Payer: Cash Price |
$178.68
|
| Rate for Payer: Cofinity Advantage |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.68
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.51
|
| Rate for Payer: PHP Commercial |
$189.85
|
| Rate for Payer: Priority Health SBD |
$140.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.18
|
| Rate for Payer: UHC Core |
$116.37
|
| Rate for Payer: UHC Exchange |
$87.78
|
| Rate for Payer: UMR Bronson Commercial |
$82.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.51
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$216.87
|
|
|
Service Code
|
NDC 51660014390
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$195.18 |
| Rate for Payer: Aetna American Axle |
$140.97
|
| Rate for Payer: Aetna Commercial |
$184.34
|
| Rate for Payer: Aetna Medicare |
$108.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.97
|
| Rate for Payer: BCBS Complete |
$86.75
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$173.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.65
|
| Rate for Payer: PHP Commercial |
$184.34
|
| Rate for Payer: Priority Health SBD |
$136.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.97
|
| Rate for Payer: UHC Core |
$112.99
|
| Rate for Payer: UHC Exchange |
$85.23
|
| Rate for Payer: UMR Bronson Commercial |
$80.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.65
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$247.10
|
|
|
Service Code
|
NDC 72819018409
|
| 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 |
$210.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.62
|
| Rate for Payer: Cash Price |
$197.68
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$210.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.32
|
| Rate for Payer: PHP Commercial |
$210.03
|
| 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
|
|
