|
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
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2,508.75
|
|
|
Service Code
|
NDC 72205001901
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,103.85 |
| Max. Negotiated Rate |
$2,257.88 |
| Rate for Payer: Aetna American Axle |
$1,630.69
|
| Rate for Payer: Aetna Commercial |
$2,132.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.69
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cofinity Commercial |
$1,756.12
|
| Rate for Payer: Cofinity Commercial |
$2,157.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.00
|
| Rate for Payer: Healthscope Commercial |
$2,257.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,756.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,881.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.44
|
| Rate for Payer: PHP Commercial |
$2,132.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.69
|
| Rate for Payer: Priority Health SBD |
$1,580.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,103.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,881.56
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2,508.75
|
|
|
Service Code
|
NDC 72205001901
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$928.24 |
| Max. Negotiated Rate |
$2,257.88 |
| Rate for Payer: Aetna American Axle |
$1,630.69
|
| Rate for Payer: Aetna Commercial |
$2,132.44
|
| Rate for Payer: Aetna Medicare |
$1,254.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.69
|
| Rate for Payer: BCBS Complete |
$1,003.50
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cofinity Commercial |
$1,756.12
|
| Rate for Payer: Cofinity Commercial |
$2,157.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.00
|
| Rate for Payer: Healthscope Commercial |
$2,257.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,756.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,881.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.44
|
| Rate for Payer: PHP Commercial |
$2,132.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.69
|
| Rate for Payer: Priority Health SBD |
$1,580.51
|
| Rate for Payer: UMR Bronson Commercial |
$928.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,881.56
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$3,682.54
|
|
|
Service Code
|
NDC 00004003909
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,362.54 |
| Max. Negotiated Rate |
$3,314.29 |
| Rate for Payer: Aetna American Axle |
$2,393.65
|
| Rate for Payer: Aetna Commercial |
$3,130.16
|
| Rate for Payer: Aetna Medicare |
$1,841.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.65
|
| Rate for Payer: BCBS Complete |
$1,473.02
|
| Rate for Payer: Cash Price |
$2,946.03
|
| Rate for Payer: Cofinity Commercial |
$2,577.78
|
| Rate for Payer: Cofinity Commercial |
$3,166.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,577.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.03
|
| Rate for Payer: Healthscope Commercial |
$3,314.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,577.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,761.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.16
|
| Rate for Payer: PHP Commercial |
$3,130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.65
|
| Rate for Payer: Priority Health SBD |
$2,320.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,362.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,761.91
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$3,682.54
|
|
|
Service Code
|
NDC 00004003909
|
| Hospital Charge Code |
99443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,620.32 |
| Max. Negotiated Rate |
$3,314.29 |
| Rate for Payer: Aetna American Axle |
$2,393.65
|
| Rate for Payer: Aetna Commercial |
$3,130.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.65
|
| Rate for Payer: Cash Price |
$2,946.03
|
| Rate for Payer: Cofinity Commercial |
$2,577.78
|
| Rate for Payer: Cofinity Commercial |
$3,166.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,577.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.03
|
| Rate for Payer: Healthscope Commercial |
$3,314.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,577.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,761.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.16
|
| Rate for Payer: PHP Commercial |
$3,130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.65
|
| Rate for Payer: Priority Health SBD |
$2,320.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,620.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,761.91
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143963710
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.82
|
|
|
Service Code
|
NDC 63323049405
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Medicare |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 70860078405
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143978501
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143978510
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.82
|
|
|
Service Code
|
NDC 63323049405
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 70860078441
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
NDC 00143963701
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143978510
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 70860078405
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.17
|
|
|
Service Code
|
NDC 00143978501
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna American Axle |
$10.51
|
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.94
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.51
|
| Rate for Payer: Priority Health SBD |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.13
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 70860078441
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.82
|
|
|
Service Code
|
NDC 63323049401
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Medicare |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.82
|
|
|
Service Code
|
NDC 63323049401
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna American Axle |
$19.38
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.36
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
OP
|
$319.20
|
|
|
Service Code
|
NDC 71930005712
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.10 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna Medicare |
$159.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: BCBS Complete |
$127.68
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$118.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 71930005712
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 69452015020
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.71
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UMR Bronson Commercial |
$133.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 00591401201
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UMR Bronson Commercial |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
