|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
|
OP
|
$13,552.11
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$9,200.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE
|
Facility
|
OP
|
$13,552.11
|
|
|
Service Code
|
CPT 58270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$9,200.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$13,552.11
|
|
|
Service Code
|
CPT 58291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$9,200.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL TISSUE (RADICAL VAGINECTOMY)
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57107
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna American Axle |
$47.74
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
VALACYCLOVIR 1 GRAM TABLET
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
13132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna American Axle |
$47.74
|
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: UMR Bronson Commercial |
$32.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
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 Commercial |
$59.37
|
| Rate for Payer: Cofinity Commercial |
$72.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.37
|
| 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: PHP Commercial |
$72.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.13
|
| 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
|
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 Commercial |
$59.37
|
| Rate for Payer: Cofinity Commercial |
$72.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.37
|
| 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: PHP Commercial |
$72.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.13
|
| Rate for Payer: Priority Health SBD |
$53.44
|
| Rate for Payer: UMR Bronson Commercial |
$31.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.62
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$494.88
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.11 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna American Axle |
$321.67
|
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna Medicare |
$247.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.67
|
| Rate for Payer: BCBS Complete |
$197.95
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Commercial |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.67
|
| Rate for Payer: Priority Health SBD |
$311.77
|
| Rate for Payer: UMR Bronson Commercial |
$183.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
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 Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.21
|
| 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: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.91
|
| 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
|
$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 Commercial |
$1,180.08
|
| Rate for Payer: Cofinity Commercial |
$960.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$960.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.75
|
| Rate for Payer: Healthscope Commercial |
$1,234.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.36
|
| Rate for Payer: PHP Commercial |
$1,166.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.92
|
| 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
|
$4,401.89
|
|
|
Service Code
|
NDC 00173093356
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,936.83 |
| Max. Negotiated Rate |
$3,961.70 |
| Rate for Payer: Aetna American Axle |
$2,861.23
|
| Rate for Payer: Aetna Commercial |
$3,741.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,861.23
|
| Rate for Payer: Cash Price |
$3,521.51
|
| Rate for Payer: Cofinity Commercial |
$3,081.32
|
| Rate for Payer: Cofinity Commercial |
$3,785.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,081.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,521.51
|
| Rate for Payer: Healthscope Commercial |
$3,961.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,081.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,301.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,741.61
|
| Rate for Payer: PHP Commercial |
$3,741.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.23
|
| Rate for Payer: Priority Health SBD |
$2,773.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,936.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,301.42
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
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 Commercial |
$1,180.08
|
| Rate for Payer: Cofinity Commercial |
$960.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$960.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.75
|
| Rate for Payer: Healthscope Commercial |
$1,234.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.36
|
| Rate for Payer: PHP Commercial |
$1,166.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.92
|
| Rate for Payer: Priority Health SBD |
$864.48
|
| 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
|
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 Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| 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: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| 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
|
$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 Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.21
|
| 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: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.91
|
| Rate for Payer: Priority Health SBD |
$66.79
|
| Rate for Payer: UMR Bronson Commercial |
$39.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$494.88
|
|
|
Service Code
|
NDC 00904656561
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$445.39 |
| Rate for Payer: Aetna American Axle |
$321.67
|
| Rate for Payer: Aetna Commercial |
$420.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.67
|
| Rate for Payer: Cash Price |
$395.90
|
| Rate for Payer: Cofinity Commercial |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$425.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.90
|
| Rate for Payer: Healthscope Commercial |
$445.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.65
|
| Rate for Payer: PHP Commercial |
$420.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.67
|
| Rate for Payer: Priority Health SBD |
$311.77
|
| Rate for Payer: UMR Bronson Commercial |
$217.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.16
|
|
|
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 Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| 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: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| 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
|
$4,401.89
|
|
|
Service Code
|
NDC 00173093356
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,628.70 |
| Max. Negotiated Rate |
$3,961.70 |
| Rate for Payer: Aetna American Axle |
$2,861.23
|
| Rate for Payer: Aetna Commercial |
$3,741.61
|
| Rate for Payer: Aetna Medicare |
$2,200.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,861.23
|
| Rate for Payer: BCBS Complete |
$1,760.76
|
| Rate for Payer: Cash Price |
$3,521.51
|
| Rate for Payer: Cofinity Commercial |
$3,081.32
|
| Rate for Payer: Cofinity Commercial |
$3,785.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,081.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,521.51
|
| Rate for Payer: Healthscope Commercial |
$3,961.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,081.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,301.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,741.61
|
| Rate for Payer: PHP Commercial |
$3,741.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.23
|
| Rate for Payer: Priority Health SBD |
$2,773.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,628.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,301.42
|
|
|
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 Commercial |
$216.66
|
| Rate for Payer: Cofinity Commercial |
$266.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.66
|
| 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: PHP Commercial |
$263.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.18
|
| 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
|
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 Commercial |
$216.66
|
| Rate for Payer: Cofinity Commercial |
$266.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.66
|
| 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: PHP Commercial |
$263.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.18
|
| Rate for Payer: Priority Health SBD |
$194.99
|
| Rate for Payer: UMR Bronson Commercial |
$114.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.13
|
|
|
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 Commercial |
$228.92
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.92
|
| 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: PHP Commercial |
$277.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.57
|
| 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
|
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 Commercial |
$228.92
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.92
|
| 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: PHP Commercial |
$277.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.57
|
| Rate for Payer: Priority Health SBD |
$206.03
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.27
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
IP
|
$515.93
|
|
|
Service Code
|
NDC 31722083260
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.01 |
| Max. Negotiated Rate |
$464.34 |
| Rate for Payer: Aetna American Axle |
$335.35
|
| Rate for Payer: Aetna Commercial |
$438.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.35
|
| Rate for Payer: Cash Price |
$412.74
|
| Rate for Payer: Cofinity Commercial |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$443.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.74
|
| Rate for Payer: Healthscope Commercial |
$464.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.54
|
| Rate for Payer: PHP Commercial |
$438.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.35
|
| Rate for Payer: Priority Health SBD |
$325.04
|
| Rate for Payer: UMR Bronson Commercial |
$227.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.95
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
|
OP
|
$515.93
|
|
|
Service Code
|
NDC 31722083260
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.89 |
| Max. Negotiated Rate |
$464.34 |
| Rate for Payer: Aetna American Axle |
$335.35
|
| Rate for Payer: Aetna Commercial |
$438.54
|
| Rate for Payer: Aetna Medicare |
$257.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.35
|
| Rate for Payer: BCBS Complete |
$206.37
|
| Rate for Payer: Cash Price |
$412.74
|
| Rate for Payer: Cofinity Commercial |
$361.15
|
| Rate for Payer: Cofinity Commercial |
$443.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$361.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.74
|
| Rate for Payer: Healthscope Commercial |
$464.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.54
|
| Rate for Payer: PHP Commercial |
$438.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.35
|
| Rate for Payer: Priority Health SBD |
$325.04
|
| Rate for Payer: UMR Bronson Commercial |
$190.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.95
|
|
|
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 Commercial |
$12,776.06
|
| Rate for Payer: Cofinity Commercial |
$15,696.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,776.06
|
| 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: PHP Commercial |
$15,513.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,863.48
|
| 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
|
|
