|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$6,355.75
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$5,746.36 |
| Max. Negotiated Rate |
$6,355.75 |
| Rate for Payer: BCBS Complete |
$6,355.75
|
| Rate for Payer: Mclaren Medicaid |
$6,053.10
|
| Rate for Payer: Meridian Medicaid |
$6,355.75
|
| Rate for Payer: PHP Medicaid |
$5,746.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,053.10
|
| Rate for Payer: UHC Medicaid |
$6,053.10
|
| Rate for Payer: UHCCP Medicaid |
$6,053.10
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$3,113.84
|
|
|
Service Code
|
APR-DRG 2821
|
| Min. Negotiated Rate |
$2,815.29 |
| Max. Negotiated Rate |
$3,113.84 |
| Rate for Payer: BCBS Complete |
$3,113.84
|
| Rate for Payer: Mclaren Medicaid |
$2,965.57
|
| Rate for Payer: Meridian Medicaid |
$3,113.84
|
| Rate for Payer: PHP Medicaid |
$2,815.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.57
|
| Rate for Payer: UHC Medicaid |
$2,965.57
|
| Rate for Payer: UHCCP Medicaid |
$2,965.57
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$12,759.46
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$11,536.08 |
| Max. Negotiated Rate |
$12,759.46 |
| Rate for Payer: BCBS Complete |
$12,759.46
|
| Rate for Payer: Mclaren Medicaid |
$12,151.87
|
| Rate for Payer: Meridian Medicaid |
$12,759.46
|
| Rate for Payer: PHP Medicaid |
$11,536.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,151.87
|
| Rate for Payer: UHC Medicaid |
$12,151.87
|
| Rate for Payer: UHCCP Medicaid |
$12,151.87
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$12,108.83
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$7,421.54 |
| Max. Negotiated Rate |
$12,108.83 |
| Rate for Payer: BCN Medicare Advantage |
$7,812.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,812.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,812.15
|
| Rate for Payer: Mclaren Medicare |
$7,812.15
|
| Rate for Payer: Aetna Medicare |
$7,812.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,765.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,765.19
|
| Rate for Payer: BCBS MAPPO |
$7,812.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,202.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,983.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,593.36
|
| Rate for Payer: PACE Medicare |
$7,421.54
|
| Rate for Payer: PACE SWMI |
$7,812.15
|
| Rate for Payer: PHP Commercial |
$8,593.36
|
| Rate for Payer: PHP Medicare Advantage |
$7,812.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,557.08
|
| Rate for Payer: Priority Health Medicare |
$7,812.15
|
| Rate for Payer: Priority Health Narrow Network |
$9,245.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7,812.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,812.15
|
| Rate for Payer: UHC Exchange |
$12,108.83
|
| Rate for Payer: UHCCP DNSP |
$7,812.15
|
| Rate for Payer: VA VA |
$7,812.15
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$22,396.99
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$12,819.23 |
| Max. Negotiated Rate |
$22,396.99 |
| Rate for Payer: Aetna Medicare |
$13,493.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,867.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,867.41
|
| Rate for Payer: BCBS MAPPO |
$13,493.93
|
| Rate for Payer: BCN Medicare Advantage |
$13,493.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,493.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,493.93
|
| Rate for Payer: Mclaren Medicare |
$13,493.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,168.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,518.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,843.32
|
| Rate for Payer: PACE Medicare |
$12,819.23
|
| Rate for Payer: PACE SWMI |
$13,493.93
|
| Rate for Payer: PHP Commercial |
$14,843.32
|
| Rate for Payer: PHP Medicare Advantage |
$13,493.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,396.99
|
| Rate for Payer: Priority Health Medicare |
$13,493.93
|
| Rate for Payer: Priority Health Narrow Network |
$17,917.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13,493.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,493.93
|
| Rate for Payer: UHC Exchange |
$20,915.59
|
| Rate for Payer: UHCCP DNSP |
$13,493.93
|
| Rate for Payer: VA VA |
$13,493.93
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$9,655.43
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,917.84 |
| Max. Negotiated Rate |
$9,655.43 |
| Rate for Payer: Aetna Medicare |
$6,229.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,786.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,786.64
|
| Rate for Payer: BCBS MAPPO |
$6,229.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,229.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,229.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,229.31
|
| Rate for Payer: Mclaren Medicare |
$6,229.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,540.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,163.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,852.24
|
| Rate for Payer: PACE Medicare |
$5,917.84
|
| Rate for Payer: PACE SWMI |
$6,229.31
|
| Rate for Payer: PHP Commercial |
$6,852.24
|
| Rate for Payer: PHP Medicare Advantage |
$6,229.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,537.29
|
| Rate for Payer: Priority Health Medicare |
$6,229.31
|
| Rate for Payer: Priority Health Narrow Network |
$6,829.83
|
| Rate for Payer: Railroad Medicare Medicare |
$6,229.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,229.31
|
| Rate for Payer: UHC Exchange |
$9,655.43
|
| Rate for Payer: UHCCP DNSP |
$6,229.31
|
| Rate for Payer: VA VA |
$6,229.31
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$27,014.60
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$15,118.55 |
| Max. Negotiated Rate |
$27,014.60 |
| Rate for Payer: Aetna Medicare |
$15,914.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,892.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,892.83
|
| Rate for Payer: BCBS MAPPO |
$15,914.26
|
| Rate for Payer: BCN Medicare Advantage |
$15,914.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,914.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,914.26
|
| Rate for Payer: Mclaren Medicare |
$15,914.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,709.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,301.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,505.69
|
| Rate for Payer: PACE Medicare |
$15,118.55
|
| Rate for Payer: PACE SWMI |
$15,914.26
|
| Rate for Payer: PHP Commercial |
$17,505.69
|
| Rate for Payer: PHP Medicare Advantage |
$15,914.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,014.60
|
| Rate for Payer: Priority Health Medicare |
$15,914.26
|
| Rate for Payer: Priority Health Narrow Network |
$21,611.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15,914.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,914.26
|
| Rate for Payer: UHC Exchange |
$24,667.10
|
| Rate for Payer: UHCCP DNSP |
$15,914.26
|
| Rate for Payer: VA VA |
$15,914.26
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$15,035.74
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$9,153.72 |
| Max. Negotiated Rate |
$15,035.74 |
| Rate for Payer: Aetna Medicare |
$9,635.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,044.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,044.36
|
| Rate for Payer: BCBS MAPPO |
$9,635.49
|
| Rate for Payer: BCN Medicare Advantage |
$9,635.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,635.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,635.49
|
| Rate for Payer: Mclaren Medicare |
$9,635.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,117.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,080.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,599.04
|
| Rate for Payer: PACE Medicare |
$9,153.72
|
| Rate for Payer: PACE SWMI |
$9,635.49
|
| Rate for Payer: PHP Commercial |
$10,599.04
|
| Rate for Payer: PHP Medicare Advantage |
$9,635.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,035.74
|
| Rate for Payer: Priority Health Medicare |
$9,635.49
|
| Rate for Payer: Priority Health Narrow Network |
$12,028.59
|
| Rate for Payer: Railroad Medicare Medicare |
$9,635.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,635.49
|
| Rate for Payer: UHC Exchange |
$14,935.01
|
| Rate for Payer: UHCCP DNSP |
$9,635.49
|
| Rate for Payer: VA VA |
$9,635.49
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$22,956.16
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,097.66 |
| Max. Negotiated Rate |
$22,956.16 |
| Rate for Payer: Aetna Medicare |
$13,787.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,233.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,233.76
|
| Rate for Payer: BCBS MAPPO |
$13,787.01
|
| Rate for Payer: BCN Medicare Advantage |
$13,787.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,787.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,787.01
|
| Rate for Payer: Mclaren Medicare |
$13,787.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,476.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,855.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,165.71
|
| Rate for Payer: PACE Medicare |
$13,097.66
|
| Rate for Payer: PACE SWMI |
$13,787.01
|
| Rate for Payer: PHP Commercial |
$15,165.71
|
| Rate for Payer: PHP Medicare Advantage |
$13,787.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,956.16
|
| Rate for Payer: Priority Health Medicare |
$13,787.01
|
| Rate for Payer: Priority Health Narrow Network |
$18,364.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13,787.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,787.01
|
| Rate for Payer: UHC Exchange |
$21,369.87
|
| Rate for Payer: UHCCP DNSP |
$13,787.01
|
| Rate for Payer: VA VA |
$13,787.01
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$11,953.66
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$7,326.44 |
| Max. Negotiated Rate |
$11,953.66 |
| Rate for Payer: Aetna Medicare |
$7,712.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,640.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,640.05
|
| Rate for Payer: BCBS MAPPO |
$7,712.04
|
| Rate for Payer: BCN Medicare Advantage |
$7,712.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,712.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,712.04
|
| Rate for Payer: Mclaren Medicare |
$7,712.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,097.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,868.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,483.24
|
| Rate for Payer: PACE Medicare |
$7,326.44
|
| Rate for Payer: PACE SWMI |
$7,712.04
|
| Rate for Payer: PHP Commercial |
$8,483.24
|
| Rate for Payer: PHP Medicare Advantage |
$7,712.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,366.11
|
| Rate for Payer: Priority Health Medicare |
$7,712.04
|
| Rate for Payer: Priority Health Narrow Network |
$9,092.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7,712.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,712.04
|
| Rate for Payer: UHC Exchange |
$11,953.66
|
| Rate for Payer: UHCCP DNSP |
$7,712.04
|
| Rate for Payer: VA VA |
$7,712.04
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 832712389
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: ASR ASR |
$1.87
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Healthscope Whirlpool |
$1.93
|
| Rate for Payer: Mclaren Commercial |
$1.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.70
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 68084077601
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.24 |
| Max. Negotiated Rate |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.29
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: BCBS Trust/PPO |
$306.84
|
| Rate for Payer: BCN Commercial |
$306.84
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$362.44
|
| Rate for Payer: Healthscope Whirlpool |
$373.65
|
| Rate for Payer: Mclaren Commercial |
$336.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 68084077611
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: Aetna Medicare |
$123.47
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.14
|
| Rate for Payer: BCN Commercial |
$275.14
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$323.69
|
| Rate for Payer: Healthscope Whirlpool |
$333.70
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.39
|
| Rate for Payer: Priority Health Narrow Network |
$233.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
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 |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.27
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 832712389
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: ASR ASR |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.58
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Healthscope Whirlpool |
$1.93
|
| Rate for Payer: Mclaren Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.70
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 832712301
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna Commercial |
$173.56
|
| Rate for Payer: Aetna Medicare |
$71.35
|
| Rate for Payer: ASR ASR |
$187.06
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS Trust/PPO |
$159.00
|
| Rate for Payer: BCN Commercial |
$159.00
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$181.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$187.06
|
| Rate for Payer: Healthscope Whirlpool |
$192.85
|
| Rate for Payer: Mclaren Commercial |
$173.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.98
|
| Rate for Payer: Priority Health Narrow Network |
$135.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.71
|
|
|
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 |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.29
|
| Rate for Payer: Aetna Medicare |
$138.25
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: BCBS Trust/PPO |
$308.07
|
| Rate for Payer: BCN Commercial |
$308.07
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$362.44
|
| Rate for Payer: Healthscope Whirlpool |
$373.65
|
| Rate for Payer: Mclaren Commercial |
$336.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$327.39
|
| Rate for Payer: Priority Health Narrow Network |
$261.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 832712301
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.64 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$187.06
|
| Rate for Payer: BCBS Trust/PPO |
$158.37
|
| Rate for Payer: BCN Commercial |
$158.37
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$181.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$187.06
|
| Rate for Payer: Healthscope Whirlpool |
$192.85
|
| Rate for Payer: Mclaren Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.71
|
|
|
DIVALPROEX 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 904686061
|
| Hospital Charge Code |
2552
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.28 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna Commercial |
$300.33
|
| Rate for Payer: ASR ASR |
$323.69
|
| Rate for Payer: BCBS Trust/PPO |
$274.03
|
| Rate for Payer: BCN Commercial |
$274.03
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$313.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$323.69
|
| Rate for Payer: Healthscope Whirlpool |
$333.70
|
| Rate for Payer: Mclaren Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.66
|
|
|
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 |
$467.65 |
| Rate for Payer: Aetna Commercial |
$420.88
|
| Rate for Payer: Aetna Medicare |
$173.03
|
| Rate for Payer: ASR ASR |
$453.62
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: BCBS Trust/PPO |
$385.58
|
| Rate for Payer: BCN Commercial |
$385.58
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$439.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$453.62
|
| Rate for Payer: Healthscope Whirlpool |
$467.65
|
| Rate for Payer: Mclaren Commercial |
$420.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$409.75
|
| Rate for Payer: Priority Health Narrow Network |
$327.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.53
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$427.20
|
|
|
Service Code
|
NDC 68084031001
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.06 |
| Max. Negotiated Rate |
$427.20 |
| Rate for Payer: Aetna Commercial |
$384.48
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: ASR ASR |
$414.38
|
| Rate for Payer: BCBS Complete |
$170.88
|
| Rate for Payer: BCBS Trust/PPO |
$352.23
|
| Rate for Payer: BCN Commercial |
$352.23
|
| Rate for Payer: Cash Price |
$341.76
|
| Rate for Payer: Cofinity Commercial |
$401.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.76
|
| Rate for Payer: Healthscope Commercial |
$414.38
|
| Rate for Payer: Healthscope Whirlpool |
$427.20
|
| Rate for Payer: Mclaren Commercial |
$384.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.12
|
| Rate for Payer: Nomi Health Commercial |
$350.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$374.31
|
| Rate for Payer: Priority Health Narrow Network |
$299.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.94
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 68084031011
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: ASR ASR |
$4.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.51
|
| Rate for Payer: BCN Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Healthscope Whirlpool |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$3.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Nomi Health Commercial |
$3.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.76
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$388.80
|
|
|
Service Code
|
NDC 904636361
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$349.92
|
| Rate for Payer: ASR ASR |
$377.14
|
| Rate for Payer: BCBS Trust/PPO |
$319.28
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$365.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$377.14
|
| Rate for Payer: Healthscope Whirlpool |
$388.80
|
| Rate for Payer: Mclaren Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.48
|
| Rate for Payer: Nomi Health Commercial |
$318.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.14
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 68084031011
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$1.58
|
| Rate for Payer: ASR ASR |
$4.14
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Healthscope Whirlpool |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$3.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Nomi Health Commercial |
$3.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.74
|
| Rate for Payer: Priority Health Narrow Network |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.76
|
|
