|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 60687086811
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$1.91
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 68084077601
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Advantage |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.87
|
| Rate for Payer: UHC Core |
$194.67
|
| Rate for Payer: UHC Exchange |
$146.84
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 60687086811
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 68084077611
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Advantage |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.43
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 62756079788
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Advantage |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.45
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 57237004801
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$190.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Advantage |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.46
|
| Rate for Payer: UHC Core |
$198.34
|
| Rate for Payer: UHC Exchange |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$140.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$221.35
|
|
|
Service Code
|
NDC 62756079888
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC Core |
$115.32
|
| Rate for Payer: UHC Exchange |
$86.99
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UMR Bronson Commercial |
$112.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 00832712489
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.33
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 57237004801
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 00904686161
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Advantage |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UMR Bronson Commercial |
$167.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$255.55
|
|
|
Service Code
|
NDC 00832712401
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$133.14
|
| Rate for Payer: UHC Exchange |
$100.43
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
DIVALPROEX 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 62756079888
|
| Hospital Charge Code |
2553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$388.80
|
|
|
Service Code
|
NDC 00904636361
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.07 |
| Max. Negotiated Rate |
$349.92 |
| Rate for Payer: Aetna American Axle |
$252.72
|
| Rate for Payer: Aetna Commercial |
$330.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.72
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Advantage |
$272.16
|
| Rate for Payer: Cofinity Commercial |
$334.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$349.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.60
|
| Rate for Payer: PHP Commercial |
$330.48
|
| Rate for Payer: Priority Health SBD |
$244.94
|
| Rate for Payer: UMR Bronson Commercial |
$171.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.60
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 65862059401
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 65862059401
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Advantage |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.69
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.66
|
| Rate for Payer: UHC Core |
$140.80
|
| Rate for Payer: UHC Exchange |
$106.21
|
| Rate for Payer: UMR Bronson Commercial |
$99.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$388.80
|
|
|
Service Code
|
NDC 00904636361
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.86 |
| Max. Negotiated Rate |
$349.92 |
| Rate for Payer: Aetna American Axle |
$252.72
|
| Rate for Payer: Aetna Commercial |
$330.48
|
| Rate for Payer: Aetna Medicare |
$194.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.72
|
| Rate for Payer: BCBS Complete |
$155.52
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Advantage |
$272.16
|
| Rate for Payer: Cofinity Commercial |
$334.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$349.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.60
|
| Rate for Payer: PHP Commercial |
$330.48
|
| Rate for Payer: Priority Health SBD |
$244.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.72
|
| Rate for Payer: UHC Core |
$202.56
|
| Rate for Payer: UHC Exchange |
$152.80
|
| Rate for Payer: UMR Bronson Commercial |
$143.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.60
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Advantage |
$417.31
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.11
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UMR Bronson Commercial |
$262.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$843.84
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.22 |
| Max. Negotiated Rate |
$759.46 |
| Rate for Payer: Aetna American Axle |
$548.50
|
| Rate for Payer: Aetna Commercial |
$717.26
|
| Rate for Payer: Aetna Medicare |
$421.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.50
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: Cash Price |
$675.07
|
| Rate for Payer: Cofinity Advantage |
$590.69
|
| Rate for Payer: Cofinity Commercial |
$725.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$675.07
|
| Rate for Payer: Healthscope Commercial |
$759.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$590.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$675.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$717.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.88
|
| Rate for Payer: PHP Commercial |
$717.26
|
| Rate for Payer: Priority Health SBD |
$531.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.50
|
| Rate for Payer: UHC Core |
$439.64
|
| Rate for Payer: UHC Exchange |
$331.63
|
| Rate for Payer: UMR Bronson Commercial |
$312.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.88
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$718.85
|
|
|
Service Code
|
NDC 00904718245
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.29 |
| Max. Negotiated Rate |
$646.97 |
| Rate for Payer: Aetna American Axle |
$467.25
|
| Rate for Payer: Aetna Commercial |
$611.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.25
|
| Rate for Payer: Cash Price |
$575.08
|
| Rate for Payer: Cofinity Advantage |
$503.19
|
| Rate for Payer: Cofinity Commercial |
$618.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.08
|
| Rate for Payer: Healthscope Commercial |
$646.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.14
|
| Rate for Payer: PHP Commercial |
$611.02
|
| Rate for Payer: Priority Health SBD |
$452.88
|
| Rate for Payer: UMR Bronson Commercial |
$316.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.14
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna Medicare |
$298.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: BCBS Complete |
$238.46
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Advantage |
$417.31
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.11
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.50
|
| Rate for Payer: UHC Core |
$310.59
|
| Rate for Payer: UHC Exchange |
$234.29
|
| Rate for Payer: UMR Bronson Commercial |
$220.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
