|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$386.65
|
|
|
Service Code
|
NDC 00832031011
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$347.99 |
| Rate for Payer: Aetna American Axle |
$251.32
|
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.32
|
| Rate for Payer: Cash Price |
$309.32
|
| Rate for Payer: Cofinity Commercial |
$270.65
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.32
|
| Rate for Payer: Healthscope Commercial |
$347.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.65
|
| Rate for Payer: PHP Commercial |
$328.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.32
|
| Rate for Payer: Priority Health SBD |
$243.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.99
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 63739008610
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$264.19 |
| Rate for Payer: Aetna American Axle |
$190.81
|
| Rate for Payer: Aetna Commercial |
$249.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.81
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$205.49
|
| Rate for Payer: Cofinity Commercial |
$252.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$264.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: PHP Commercial |
$249.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: Priority Health SBD |
$184.94
|
| Rate for Payer: UMR Bronson Commercial |
$129.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.16
|
|
|
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
|
$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
|
$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
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 00591401201
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna American Axle |
$229.71
|
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: BCBS Complete |
$141.36
|
| 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 |
$130.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$8.43
|
|
|
Service Code
|
NDC 00121467540
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna American Axle |
$5.48
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.48
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.48
|
| Rate for Payer: Priority Health SBD |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.32
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$5.57
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$5.57
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 68094019361
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$5.57
|
|
|
Service Code
|
NDC 00121467500
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$5.57
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna American Axle |
$3.62
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.62
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.62
|
| Rate for Payer: Priority Health SBD |
$3.51
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.18
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 68094019362
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 68094019361
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
NDC 09900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna American Axle |
$1.15
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
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 Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| 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
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 68094019359
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.69
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
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 Commercial |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.69
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| 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
|
$4.33
|
|
|
Service Code
|
NDC 68094019362
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$8.43
|
|
|
Service Code
|
NDC 00121467540
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna American Axle |
$5.48
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.48
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.48
|
| Rate for Payer: Priority Health SBD |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.32
|
|
|
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 Commercial |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$305.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.99
|
| 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: PHP Commercial |
$302.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.21
|
| 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
|
$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 Commercial |
$101.16
|
| Rate for Payer: Cofinity Commercial |
$124.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.16
|
| 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: PHP Commercial |
$122.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.93
|
| Rate for Payer: Priority Health SBD |
$91.04
|
| 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
|
$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 Commercial |
$210.08
|
| Rate for Payer: Cofinity Commercial |
$258.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.08
|
| 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: PHP Commercial |
$255.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.08
|
| Rate for Payer: Priority Health SBD |
$189.08
|
| Rate for Payer: UMR Bronson Commercial |
$132.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
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 Commercial |
$101.16
|
| Rate for Payer: Cofinity Commercial |
$124.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.16
|
| 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: PHP Commercial |
$122.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.93
|
| 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
|
OP
|
$344.59
|
|
|
Service Code
|
NDC 62559026616
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$310.13 |
| Rate for Payer: Aetna American Axle |
$223.98
|
| Rate for Payer: Aetna Commercial |
$292.90
|
| Rate for Payer: Aetna Medicare |
$172.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.98
|
| Rate for Payer: BCBS Complete |
$137.84
|
| Rate for Payer: Cash Price |
$275.67
|
| Rate for Payer: Cofinity Commercial |
$241.21
|
| Rate for Payer: Cofinity Commercial |
$296.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.67
|
| Rate for Payer: Healthscope Commercial |
$310.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.90
|
| Rate for Payer: PHP Commercial |
$292.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.98
|
| Rate for Payer: Priority Health SBD |
$217.09
|
| Rate for Payer: UMR Bronson Commercial |
$127.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.44
|
|
