|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$4,122.00
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$3,726.78 |
| Max. Negotiated Rate |
$4,122.00 |
| Rate for Payer: BCBS Complete |
$4,122.00
|
| Rate for Payer: Mclaren Medicaid |
$3,925.72
|
| Rate for Payer: Meridian Medicaid |
$4,122.00
|
| Rate for Payer: PHP Medicaid |
$3,726.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,925.72
|
| Rate for Payer: UHC Medicaid |
$3,925.72
|
| Rate for Payer: UHCCP Medicaid |
$3,925.72
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$5,409.72
|
|
|
Service Code
|
APR-DRG 5413
|
| Min. Negotiated Rate |
$4,891.03 |
| Max. Negotiated Rate |
$5,409.72 |
| Rate for Payer: BCBS Complete |
$5,409.72
|
| Rate for Payer: Mclaren Medicaid |
$5,152.11
|
| Rate for Payer: Meridian Medicaid |
$5,409.72
|
| Rate for Payer: PHP Medicaid |
$4,891.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,152.11
|
| Rate for Payer: UHC Medicaid |
$5,152.11
|
| Rate for Payer: UHCCP Medicaid |
$5,152.11
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,202.13
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$2,895.11 |
| Max. Negotiated Rate |
$3,202.13 |
| Rate for Payer: BCBS Complete |
$3,202.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.13
|
| Rate for Payer: PHP Medicaid |
$2,895.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.64
|
| Rate for Payer: UHC Medicaid |
$3,049.64
|
| Rate for Payer: UHCCP Medicaid |
$3,049.64
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$13,885.80
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$5,788.98 |
| Max. Negotiated Rate |
$13,885.80 |
| Rate for Payer: Aetna Medicare |
$8,958.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,198.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,198.23
|
| Rate for Payer: BCBS MAPPO |
$8,958.58
|
| Rate for Payer: BCN Medicare Advantage |
$8,958.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,958.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,958.58
|
| Rate for Payer: Mclaren Medicare |
$8,958.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,406.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,302.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,854.44
|
| Rate for Payer: PACE Medicare |
$8,510.65
|
| Rate for Payer: PACE SWMI |
$8,958.58
|
| Rate for Payer: PHP Commercial |
$9,854.44
|
| Rate for Payer: PHP Medicare Advantage |
$8,958.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,236.23
|
| Rate for Payer: Priority Health Medicare |
$8,958.58
|
| Rate for Payer: Priority Health Narrow Network |
$5,788.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8,958.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,958.58
|
| Rate for Payer: UHC Exchange |
$13,885.80
|
| Rate for Payer: UHCCP DNSP |
$8,958.58
|
| Rate for Payer: VA VA |
$8,958.58
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$15,745.38
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$9,650.39 |
| Max. Negotiated Rate |
$15,745.38 |
| Rate for Payer: Aetna Medicare |
$10,158.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,697.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,697.89
|
| Rate for Payer: BCBS MAPPO |
$10,158.31
|
| Rate for Payer: BCN Medicare Advantage |
$10,158.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,158.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,158.31
|
| Rate for Payer: Mclaren Medicare |
$10,158.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,666.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,682.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,174.14
|
| Rate for Payer: PACE Medicare |
$9,650.39
|
| Rate for Payer: PACE SWMI |
$10,158.31
|
| Rate for Payer: PHP Commercial |
$11,174.14
|
| Rate for Payer: PHP Medicare Advantage |
$10,158.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,544.90
|
| Rate for Payer: Priority Health Medicare |
$10,158.31
|
| Rate for Payer: Priority Health Narrow Network |
$10,035.92
|
| Rate for Payer: Railroad Medicare Medicare |
$10,158.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,158.31
|
| Rate for Payer: UHC Exchange |
$15,745.38
|
| Rate for Payer: UHCCP DNSP |
$10,158.31
|
| Rate for Payer: VA VA |
$10,158.31
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$13,402.48
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,788.98 |
| Max. Negotiated Rate |
$13,402.48 |
| Rate for Payer: Aetna Medicare |
$8,646.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,808.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,808.45
|
| Rate for Payer: BCBS MAPPO |
$8,646.76
|
| Rate for Payer: BCN Medicare Advantage |
$8,646.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,646.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,646.76
|
| Rate for Payer: Mclaren Medicare |
$8,646.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,079.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,943.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,511.44
|
| Rate for Payer: PACE Medicare |
$8,214.42
|
| Rate for Payer: PACE SWMI |
$8,646.76
|
| Rate for Payer: PHP Commercial |
$9,511.44
|
| Rate for Payer: PHP Medicare Advantage |
$8,646.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,236.23
|
| Rate for Payer: Priority Health Medicare |
$8,646.76
|
| Rate for Payer: Priority Health Narrow Network |
$5,788.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8,646.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,646.76
|
| Rate for Payer: UHC Exchange |
$13,402.48
|
| Rate for Payer: UHCCP DNSP |
$8,646.76
|
| Rate for Payer: VA VA |
$8,646.76
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$76.75
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.08
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: ASR ASR |
$74.45
|
| Rate for Payer: BCBS Complete |
$30.70
|
| Rate for Payer: BCBS Trust/PPO |
$63.28
|
| Rate for Payer: BCN Commercial |
$63.28
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$72.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$74.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.75
|
| Rate for Payer: Mclaren Commercial |
$69.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.24
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.25
|
| Rate for Payer: Priority Health Narrow Network |
$53.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.54
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$76.75
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.08
|
| Rate for Payer: ASR ASR |
$74.45
|
| Rate for Payer: BCBS Trust/PPO |
$63.03
|
| Rate for Payer: BCN Commercial |
$63.03
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$72.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$74.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.75
|
| Rate for Payer: Mclaren Commercial |
$69.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.24
|
| Rate for Payer: Nomi Health Commercial |
$62.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.54
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$296.48
|
|
|
Service Code
|
NDC 904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.36 |
| Max. Negotiated Rate |
$296.48 |
| Rate for Payer: Aetna Commercial |
$266.83
|
| Rate for Payer: ASR ASR |
$287.59
|
| Rate for Payer: BCBS Trust/PPO |
$243.47
|
| Rate for Payer: BCN Commercial |
$243.47
|
| Rate for Payer: Cash Price |
$237.18
|
| Rate for Payer: Cofinity Commercial |
$278.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.18
|
| Rate for Payer: Healthscope Commercial |
$287.59
|
| Rate for Payer: Healthscope Whirlpool |
$296.48
|
| Rate for Payer: Mclaren Commercial |
$266.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.01
|
| Rate for Payer: Nomi Health Commercial |
$243.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.90
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$332.40
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$299.16
|
| Rate for Payer: ASR ASR |
$322.43
|
| Rate for Payer: BCBS Trust/PPO |
$272.97
|
| Rate for Payer: BCN Commercial |
$272.97
|
| Rate for Payer: Cash Price |
$265.92
|
| Rate for Payer: Cofinity Commercial |
$312.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.92
|
| Rate for Payer: Healthscope Commercial |
$322.43
|
| Rate for Payer: Healthscope Whirlpool |
$332.40
|
| Rate for Payer: Mclaren Commercial |
$299.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.54
|
| Rate for Payer: Nomi Health Commercial |
$272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.51
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: ASR ASR |
$6.45
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$5.48
|
| Rate for Payer: BCN Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Healthscope Whirlpool |
$6.65
|
| Rate for Payer: Mclaren Commercial |
$5.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.65
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.82
|
| Rate for Payer: Priority Health Narrow Network |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.85
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 50268078811
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: ASR ASR |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCN Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$6.45
|
| Rate for Payer: Healthscope Whirlpool |
$6.65
|
| Rate for Payer: Mclaren Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.65
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.85
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
IP
|
$74.67
|
|
|
Service Code
|
NDC 378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$74.67 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: ASR ASR |
$72.43
|
| Rate for Payer: BCBS Trust/PPO |
$61.32
|
| Rate for Payer: BCN Commercial |
$61.32
|
| Rate for Payer: Cash Price |
$59.74
|
| Rate for Payer: Cofinity Commercial |
$70.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.74
|
| Rate for Payer: Healthscope Commercial |
$72.43
|
| Rate for Payer: Healthscope Whirlpool |
$74.67
|
| Rate for Payer: Mclaren Commercial |
$67.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.47
|
| Rate for Payer: Nomi Health Commercial |
$61.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.71
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$332.40
|
|
|
Service Code
|
NDC 50268078815
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$299.16
|
| Rate for Payer: Aetna Medicare |
$122.99
|
| Rate for Payer: ASR ASR |
$322.43
|
| Rate for Payer: BCBS Complete |
$132.96
|
| Rate for Payer: BCBS Trust/PPO |
$274.06
|
| Rate for Payer: BCN Commercial |
$274.06
|
| Rate for Payer: Cash Price |
$265.92
|
| Rate for Payer: Cofinity Commercial |
$312.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.92
|
| Rate for Payer: Healthscope Commercial |
$322.43
|
| Rate for Payer: Healthscope Whirlpool |
$332.40
|
| Rate for Payer: Mclaren Commercial |
$299.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.54
|
| Rate for Payer: Nomi Health Commercial |
$272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$291.25
|
| Rate for Payer: Priority Health Narrow Network |
$233.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.51
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$296.48
|
|
|
Service Code
|
NDC 904656507
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$296.48 |
| Rate for Payer: Aetna Commercial |
$266.83
|
| Rate for Payer: Aetna Medicare |
$109.70
|
| Rate for Payer: ASR ASR |
$287.59
|
| Rate for Payer: BCBS Complete |
$118.59
|
| Rate for Payer: BCBS Trust/PPO |
$244.45
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$237.18
|
| Rate for Payer: Cofinity Commercial |
$278.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.18
|
| Rate for Payer: Healthscope Commercial |
$287.59
|
| Rate for Payer: Healthscope Whirlpool |
$296.48
|
| Rate for Payer: Mclaren Commercial |
$266.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.01
|
| Rate for Payer: Nomi Health Commercial |
$243.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$259.78
|
| Rate for Payer: Priority Health Narrow Network |
$207.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.90
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
|
OP
|
$74.67
|
|
|
Service Code
|
NDC 378427593
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$74.67 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: Aetna Medicare |
$27.63
|
| Rate for Payer: ASR ASR |
$72.43
|
| Rate for Payer: BCBS Complete |
$29.87
|
| Rate for Payer: BCBS Trust/PPO |
$61.57
|
| Rate for Payer: BCN Commercial |
$61.57
|
| Rate for Payer: Cash Price |
$59.74
|
| Rate for Payer: Cofinity Commercial |
$70.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.74
|
| Rate for Payer: Healthscope Commercial |
$72.43
|
| Rate for Payer: Healthscope Whirlpool |
$74.67
|
| Rate for Payer: Mclaren Commercial |
$67.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.47
|
| Rate for Payer: Nomi Health Commercial |
$61.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.43
|
| Rate for Payer: Priority Health Narrow Network |
$52.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.71
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$13.62
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: ASR ASR |
$16.01
|
| Rate for Payer: ASR ASR |
$14.68
|
| Rate for Payer: BCBS Complete |
$6.05
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.61
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: BCN Commercial |
$13.61
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$14.68
|
| Rate for Payer: Healthscope Commercial |
$16.01
|
| Rate for Payer: Healthscope Whirlpool |
$16.50
|
| Rate for Payer: Healthscope Whirlpool |
$15.13
|
| Rate for Payer: Mclaren Commercial |
$14.85
|
| Rate for Payer: Mclaren Commercial |
$13.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$12.41
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.13
|
|
|
Service Code
|
HCPCS J3379
|
| Hospital Charge Code |
20887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna Commercial |
$13.62
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: ASR ASR |
$14.68
|
| Rate for Payer: ASR ASR |
$16.01
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.55
|
| Rate for Payer: BCN Commercial |
$12.43
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.20
|
| Rate for Payer: Healthscope Commercial |
$14.68
|
| Rate for Payer: Healthscope Commercial |
$16.01
|
| Rate for Payer: Healthscope Whirlpool |
$16.50
|
| Rate for Payer: Healthscope Whirlpool |
$15.13
|
| Rate for Payer: Mclaren Commercial |
$14.85
|
| Rate for Payer: Mclaren Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.86
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$12.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 69452015020
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.91 |
| Max. Negotiated Rate |
$406.55 |
| Rate for Payer: Aetna Commercial |
$365.89
|
| Rate for Payer: ASR ASR |
$394.35
|
| Rate for Payer: BCBS Trust/PPO |
$333.86
|
| Rate for Payer: BCN Commercial |
$333.86
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$382.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$394.35
|
| Rate for Payer: Healthscope Whirlpool |
$406.55
|
| Rate for Payer: Mclaren Commercial |
$365.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Nomi Health Commercial |
$333.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.76
|
|
|
VALPROIC ACID 250 MG CAPSULE
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 69452015020
|
| Hospital Charge Code |
8429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$406.55 |
| Rate for Payer: Aetna Commercial |
$365.89
|
| Rate for Payer: Aetna Medicare |
$150.42
|
| Rate for Payer: ASR ASR |
$394.35
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: BCBS Trust/PPO |
$335.20
|
| Rate for Payer: BCN Commercial |
$335.20
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$382.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$394.35
|
| Rate for Payer: Healthscope Whirlpool |
$406.55
|
| Rate for Payer: Mclaren Commercial |
$365.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Nomi Health Commercial |
$333.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$356.22
|
| Rate for Payer: Priority Health Narrow Network |
$284.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.76
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$6.38
|
|
|
Service Code
|
NDC 121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$6.19
|
| Rate for Payer: Healthscope Whirlpool |
$6.38
|
| Rate for Payer: Mclaren Commercial |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.59
|
| Rate for Payer: Priority Health Narrow Network |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.62
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 9900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 9900001951
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.55
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$6.38
|
|
|
Service Code
|
NDC 121467505
|
| Hospital Charge Code |
150931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: ASR ASR |
$6.19
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$6.19
|
| Rate for Payer: Healthscope Whirlpool |
$6.38
|
| Rate for Payer: Mclaren Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.62
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$355.70
|
|
|
Service Code
|
NDC 121067585
|
| Hospital Charge Code |
8428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.77 |
| Max. Negotiated Rate |
$355.70 |
| Rate for Payer: Aetna Commercial |
$320.13
|
| Rate for Payer: ASR ASR |
$345.03
|
| Rate for Payer: BCBS Trust/PPO |
$292.10
|
| Rate for Payer: BCN Commercial |
$292.10
|
| Rate for Payer: Cash Price |
$284.56
|
| Rate for Payer: Cofinity Commercial |
$334.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.56
|
| Rate for Payer: Healthscope Commercial |
$345.03
|
| Rate for Payer: Healthscope Whirlpool |
$355.70
|
| Rate for Payer: Mclaren Commercial |
$320.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.34
|
| Rate for Payer: Nomi Health Commercial |
$291.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.01
|
|
