|
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 |
$2.78
|
| 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 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
|
$300.12
|
|
|
Service Code
|
NDC 60432062116
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Aetna American Axle |
$195.08
|
| Rate for Payer: Aetna Commercial |
$255.10
|
| Rate for Payer: Aetna Medicare |
$150.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.08
|
| Rate for Payer: BCBS Complete |
$120.05
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cofinity 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 |
$111.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.09
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$344.59
|
|
|
Service Code
|
NDC 62559026616
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$310.13 |
| Rate for Payer: Aetna American Axle |
$223.98
|
| Rate for Payer: Aetna Commercial |
$292.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.98
|
| 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 |
$151.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.44
|
|
|
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 |
$72.26
|
| 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
|
$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 |
$231.20
|
| Rate for Payer: Aetna Commercial |
$302.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.20
|
| 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 |
$266.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.34
|
| Rate for Payer: PHP Commercial |
$302.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.20
|
| 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 |
$266.78
|
|
|
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
|
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 |
$172.30
|
| 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
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$355.70
|
|
|
Service Code
|
NDC 00121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.61 |
| Max. Negotiated Rate |
$320.13 |
| Rate for Payer: Aetna American Axle |
$231.20
|
| Rate for Payer: Aetna Commercial |
$302.34
|
| Rate for Payer: Aetna Medicare |
$177.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.20
|
| Rate for Payer: BCBS Complete |
$142.28
|
| 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 |
$266.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.34
|
| Rate for Payer: PHP Commercial |
$302.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.20
|
| Rate for Payer: Priority Health SBD |
$224.09
|
| Rate for Payer: UMR Bronson Commercial |
$131.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.78
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
IP
|
$6,578.68
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,894.62 |
| Max. Negotiated Rate |
$5,920.81 |
| Rate for Payer: Aetna American Axle |
$4,276.14
|
| Rate for Payer: Aetna American Axle |
$3,172.81
|
| Rate for Payer: Aetna Commercial |
$4,149.06
|
| Rate for Payer: Aetna Commercial |
$5,591.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,276.14
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cash Price |
$5,262.94
|
| Rate for Payer: Cofinity Commercial |
$4,197.88
|
| Rate for Payer: Cofinity Commercial |
$3,416.88
|
| Rate for Payer: Cofinity Commercial |
$4,605.08
|
| Rate for Payer: Cofinity Commercial |
$5,657.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,416.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,605.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,262.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.00
|
| Rate for Payer: Healthscope Commercial |
$4,393.12
|
| Rate for Payer: Healthscope Commercial |
$5,920.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,605.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,934.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,149.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,591.88
|
| Rate for Payer: PHP Commercial |
$4,149.06
|
| Rate for Payer: PHP Commercial |
$5,591.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,276.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,172.81
|
| Rate for Payer: Priority Health SBD |
$3,075.19
|
| Rate for Payer: Priority Health SBD |
$4,144.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,894.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,147.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,934.01
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION
|
Facility
|
OP
|
$4,881.25
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$746.39 |
| Max. Negotiated Rate |
$4,393.12 |
| Rate for Payer: Aetna American Axle |
$3,172.81
|
| Rate for Payer: Aetna American Axle |
$4,276.14
|
| Rate for Payer: Aetna Commercial |
$5,591.88
|
| Rate for Payer: Aetna Commercial |
$4,149.06
|
| Rate for Payer: Aetna Medicare |
$1,448.22
|
| Rate for Payer: Aetna Medicare |
$1,448.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,276.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.65
|
| Rate for Payer: BCBS Complete |
$783.71
|
| Rate for Payer: BCBS Complete |
$783.71
|
| Rate for Payer: BCBS MAPPO |
$1,392.52
|
| Rate for Payer: BCBS MAPPO |
$1,392.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,874.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,874.83
|
| Rate for Payer: BCN Commercial |
$3,874.83
|
| Rate for Payer: BCN Commercial |
$3,874.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.52
|
| Rate for Payer: Cash Price |
$5,262.94
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cash Price |
$5,262.94
|
| Rate for Payer: Cash Price |
$3,905.00
|
| Rate for Payer: Cofinity Commercial |
$4,605.08
|
| Rate for Payer: Cofinity Commercial |
$3,416.88
|
| Rate for Payer: Cofinity Commercial |
$4,197.88
|
| Rate for Payer: Cofinity Commercial |
$5,657.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,416.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,605.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,905.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,262.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.52
|
| Rate for Payer: Healthscope Commercial |
$4,393.12
|
| Rate for Payer: Healthscope Commercial |
$5,920.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,605.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,934.01
|
| Rate for Payer: Mclaren Medicaid |
$746.39
|
| Rate for Payer: Mclaren Medicaid |
$746.39
|
| Rate for Payer: Mclaren Medicare |
$1,392.52
|
| Rate for Payer: Mclaren Medicare |
$1,392.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,462.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,462.15
|
| Rate for Payer: Meridian Medicaid |
$783.71
|
| Rate for Payer: Meridian Medicaid |
$783.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,601.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,601.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,149.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,591.88
|
| Rate for Payer: Nomi Health Commercial |
$4,177.56
|
| Rate for Payer: Nomi Health Commercial |
$4,177.56
|
| Rate for Payer: PACE Medicare |
$1,322.89
|
| Rate for Payer: PACE Medicare |
$1,322.89
|
| Rate for Payer: PACE SWMI |
$1,392.52
|
| Rate for Payer: PACE SWMI |
$1,392.52
|
| Rate for Payer: PHP Commercial |
$4,149.06
|
| Rate for Payer: PHP Commercial |
$5,591.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,276.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,135.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,135.93
|
| Rate for Payer: Priority Health Medicare |
$1,392.52
|
| Rate for Payer: Priority Health Medicare |
$1,392.52
|
| Rate for Payer: Priority Health Narrow Network |
$3,308.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,308.74
|
| Rate for Payer: Priority Health SBD |
$3,075.19
|
| Rate for Payer: Priority Health SBD |
$4,144.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,919.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,919.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.52
|
| Rate for Payer: UHC Exchange |
$2,661.24
|
| Rate for Payer: UHC Exchange |
$2,661.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,392.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,392.52
|
| Rate for Payer: UHCCP Medicaid |
$746.39
|
| Rate for Payer: UHCCP Medicaid |
$746.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,806.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,434.11
|
| Rate for Payer: VA VA |
$1,392.52
|
| Rate for Payer: VA VA |
$1,392.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,934.01
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$247.10
|
|
|
Service Code
|
NDC 72819018409
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$222.39 |
| Rate for Payer: Aetna American Axle |
$160.62
|
| Rate for Payer: Aetna Commercial |
$210.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.62
|
| Rate for Payer: Cash Price |
$197.68
|
| Rate for Payer: Cofinity Commercial |
$172.97
|
| Rate for Payer: Cofinity Commercial |
$212.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.68
|
| Rate for Payer: Healthscope Commercial |
$222.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.04
|
| Rate for Payer: PHP Commercial |
$210.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.62
|
| Rate for Payer: Priority Health SBD |
$155.67
|
| Rate for Payer: UMR Bronson Commercial |
$108.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.32
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$247.10
|
|
|
Service Code
|
NDC 72819018409
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$222.39 |
| Rate for Payer: Aetna American Axle |
$160.62
|
| Rate for Payer: Aetna Commercial |
$210.04
|
| Rate for Payer: Aetna Medicare |
$123.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.62
|
| Rate for Payer: BCBS Complete |
$98.84
|
| Rate for Payer: Cash Price |
$197.68
|
| Rate for Payer: Cofinity Commercial |
$172.97
|
| Rate for Payer: Cofinity Commercial |
$212.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.68
|
| Rate for Payer: Healthscope Commercial |
$222.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.04
|
| Rate for Payer: PHP Commercial |
$210.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.62
|
| Rate for Payer: Priority Health SBD |
$155.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.32
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$265.91
|
|
|
Service Code
|
NDC 43547037009
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.39 |
| Max. Negotiated Rate |
$239.32 |
| Rate for Payer: Aetna American Axle |
$172.84
|
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.84
|
| Rate for Payer: BCBS Complete |
$106.36
|
| Rate for Payer: Cash Price |
$212.73
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$228.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.73
|
| Rate for Payer: Healthscope Commercial |
$239.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.02
|
| Rate for Payer: PHP Commercial |
$226.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.84
|
| Rate for Payer: Priority Health SBD |
$167.52
|
| Rate for Payer: UMR Bronson Commercial |
$98.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.43
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$257.36
|
|
|
Service Code
|
NDC 59746036390
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna American Axle |
$167.28
|
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna Medicare |
$128.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: BCBS Complete |
$102.94
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health SBD |
$162.14
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.02
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$257.36
|
|
|
Service Code
|
NDC 59746036390
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.24 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna American Axle |
$167.28
|
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health SBD |
$162.14
|
| Rate for Payer: UMR Bronson Commercial |
$113.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.02
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$223.35
|
|
|
Service Code
|
NDC 00378581577
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$201.02 |
| Rate for Payer: Aetna American Axle |
$145.18
|
| Rate for Payer: Aetna Commercial |
$189.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.18
|
| Rate for Payer: Cash Price |
$178.68
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.68
|
| Rate for Payer: Healthscope Commercial |
$201.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.85
|
| Rate for Payer: PHP Commercial |
$189.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.18
|
| Rate for Payer: Priority Health SBD |
$140.71
|
| Rate for Payer: UMR Bronson Commercial |
$98.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.51
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$3,894.44
|
|
|
Service Code
|
NDC 00078036034
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,713.55 |
| Max. Negotiated Rate |
$3,505.00 |
| Rate for Payer: Aetna American Axle |
$2,531.39
|
| Rate for Payer: Aetna Commercial |
$3,310.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.39
|
| Rate for Payer: Cash Price |
$3,115.55
|
| Rate for Payer: Cofinity Commercial |
$2,726.11
|
| Rate for Payer: Cofinity Commercial |
$3,349.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,726.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.55
|
| Rate for Payer: Healthscope Commercial |
$3,505.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,726.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,920.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,310.27
|
| Rate for Payer: PHP Commercial |
$3,310.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.39
|
| Rate for Payer: Priority Health SBD |
$2,453.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,713.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,920.83
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$216.87
|
|
|
Service Code
|
NDC 51660014390
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$195.18 |
| Rate for Payer: Aetna American Axle |
$140.97
|
| Rate for Payer: Aetna Commercial |
$184.34
|
| Rate for Payer: Aetna Medicare |
$108.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.97
|
| Rate for Payer: BCBS Complete |
$86.75
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cofinity Commercial |
$151.81
|
| Rate for Payer: Cofinity Commercial |
$186.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.50
|
| Rate for Payer: Healthscope Commercial |
$195.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.34
|
| Rate for Payer: PHP Commercial |
$184.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health SBD |
$136.63
|
| Rate for Payer: UMR Bronson Commercial |
$80.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.65
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$223.35
|
|
|
Service Code
|
NDC 00378581577
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$201.02 |
| Rate for Payer: Aetna American Axle |
$145.18
|
| Rate for Payer: Aetna Commercial |
$189.85
|
| Rate for Payer: Aetna Medicare |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.18
|
| Rate for Payer: BCBS Complete |
$89.34
|
| Rate for Payer: Cash Price |
$178.68
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.68
|
| Rate for Payer: Healthscope Commercial |
$201.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.85
|
| Rate for Payer: PHP Commercial |
$189.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.18
|
| Rate for Payer: Priority Health SBD |
$140.71
|
| Rate for Payer: UMR Bronson Commercial |
$82.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.51
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$216.87
|
|
|
Service Code
|
NDC 51660014390
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$195.18 |
| Rate for Payer: Aetna American Axle |
$140.97
|
| Rate for Payer: Aetna Commercial |
$184.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.97
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cofinity Commercial |
$151.81
|
| Rate for Payer: Cofinity Commercial |
$186.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.50
|
| Rate for Payer: Healthscope Commercial |
$195.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.34
|
| Rate for Payer: PHP Commercial |
$184.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health SBD |
$136.63
|
| Rate for Payer: UMR Bronson Commercial |
$95.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.65
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
IP
|
$265.91
|
|
|
Service Code
|
NDC 43547037009
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$239.32 |
| Rate for Payer: Aetna American Axle |
$172.84
|
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.84
|
| Rate for Payer: Cash Price |
$212.73
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$228.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.73
|
| Rate for Payer: Healthscope Commercial |
$239.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.02
|
| Rate for Payer: PHP Commercial |
$226.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.84
|
| Rate for Payer: Priority Health SBD |
$167.52
|
| Rate for Payer: UMR Bronson Commercial |
$117.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.43
|
|
|
VALSARTAN 320 MG TABLET
|
Facility
|
OP
|
$3,894.44
|
|
|
Service Code
|
NDC 00078036034
|
| Hospital Charge Code |
31211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$3,505.00 |
| Rate for Payer: Aetna American Axle |
$2,531.39
|
| Rate for Payer: Aetna Commercial |
$3,310.27
|
| Rate for Payer: Aetna Medicare |
$1,947.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.39
|
| Rate for Payer: BCBS Complete |
$1,557.78
|
| Rate for Payer: Cash Price |
$3,115.55
|
| Rate for Payer: Cofinity Commercial |
$2,726.11
|
| Rate for Payer: Cofinity Commercial |
$3,349.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,726.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.55
|
| Rate for Payer: Healthscope Commercial |
$3,505.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,726.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,920.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,310.27
|
| Rate for Payer: PHP Commercial |
$3,310.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.39
|
| Rate for Payer: Priority Health SBD |
$2,453.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,440.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,920.83
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$111.46
|
|
|
Service Code
|
NDC 60687061221
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Aetna American Axle |
$72.45
|
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Medicare |
$55.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.45
|
| Rate for Payer: BCBS Complete |
$44.58
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Cofinity Commercial |
$95.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.17
|
| Rate for Payer: Healthscope Commercial |
$100.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.74
|
| Rate for Payer: PHP Commercial |
$94.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.45
|
| Rate for Payer: Priority Health SBD |
$70.22
|
| Rate for Payer: UMR Bronson Commercial |
$41.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.60
|
|
|
VALSARTAN 40 MG TABLET
|
Facility
|
OP
|
$61.56
|
|
|
Service Code
|
NDC 43547036703
|
| Hospital Charge Code |
33541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna American Axle |
$40.01
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$30.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: BCBS Complete |
$24.62
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.33
|
| Rate for Payer: PHP Commercial |
$52.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.01
|
| Rate for Payer: Priority Health SBD |
$38.78
|
| Rate for Payer: UMR Bronson Commercial |
$22.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.17
|
|
