Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

VALACYCLOVIR 500 MG TABLET

Facility

$76.75

Service Code	NDC 59746032430
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$49.89
Max. Negotiated Rate	$76.75
Rate for Payer: Aetna Commercial	$69.08
Rate for Payer: ASR ASR	$74.45
Rate for Payer: ASR Commercial	$74.45
Rate for Payer: BCBS Trust/PPO	$62.54
Rate for Payer: BCN Commercial	$59.50
Rate for Payer: Cash Price	$61.40
Rate for Payer: Cofinity Commercial	$72.14
Rate for Payer: Encore Health Key Benefits Commercial	$61.40
Rate for Payer: Healthscope Commercial	$76.75
Rate for Payer: Healthscope Whirlpool	$74.45
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: Priority Health Cigna Priority Health	$49.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$67.54

VALACYCLOVIR 500 MG TABLET

Facility

$307.68

Service Code	NDC 50268078815
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$199.99
Max. Negotiated Rate	$307.68
Rate for Payer: Aetna Commercial	$276.91
Rate for Payer: ASR ASR	$298.45
Rate for Payer: ASR Commercial	$298.45
Rate for Payer: BCBS Trust/PPO	$250.73
Rate for Payer: BCN Commercial	$238.54
Rate for Payer: Cash Price	$246.14
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Encore Health Key Benefits Commercial	$246.14
Rate for Payer: Healthscope Commercial	$307.68
Rate for Payer: Healthscope Whirlpool	$298.45
Rate for Payer: Mclaren Commercial	$276.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.53
Rate for Payer: Nomi Health Commercial	$252.30
Rate for Payer: Priority Health Cigna Priority Health	$199.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.76

VALACYCLOVIR 500 MG TABLET

Facility

$274.61

Service Code	NDC 00904656507
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$274.61
Rate for Payer: Aetna Commercial	$247.15
Rate for Payer: ASR ASR	$266.37
Rate for Payer: ASR Commercial	$266.37
Rate for Payer: BCBS Trust/PPO	$223.78
Rate for Payer: BCN Commercial	$212.91
Rate for Payer: Cash Price	$219.69
Rate for Payer: Cofinity Commercial	$258.13
Rate for Payer: Encore Health Key Benefits Commercial	$219.69
Rate for Payer: Healthscope Commercial	$274.61
Rate for Payer: Healthscope Whirlpool	$266.37
Rate for Payer: Mclaren Commercial	$247.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.42
Rate for Payer: Nomi Health Commercial	$225.18
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$241.66

VALACYCLOVIR 500 MG TABLET

Facility

$307.68

Service Code	NDC 50268078815
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$123.07
Max. Negotiated Rate	$307.68
Rate for Payer: Aetna Commercial	$276.91
Rate for Payer: Aetna Medicare	$153.84
Rate for Payer: ASR ASR	$298.45
Rate for Payer: ASR Commercial	$298.45
Rate for Payer: BCBS Complete	$123.07
Rate for Payer: BCBS Trust/PPO	$251.96
Rate for Payer: BCN Commercial	$238.54
Rate for Payer: Cash Price	$246.14
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Encore Health Key Benefits Commercial	$246.14
Rate for Payer: Healthscope Commercial	$307.68
Rate for Payer: Healthscope Whirlpool	$298.45
Rate for Payer: Mclaren Commercial	$276.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.53
Rate for Payer: Nomi Health Commercial	$252.30
Rate for Payer: Priority Health Cigna Priority Health	$199.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.59
Rate for Payer: Priority Health Narrow Network	$215.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$270.76

VALACYCLOVIR 500 MG TABLET

Facility

$274.61

Service Code	NDC 00904656507
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$109.84
Max. Negotiated Rate	$274.61
Rate for Payer: Aetna Commercial	$247.15
Rate for Payer: Aetna Medicare	$137.30
Rate for Payer: ASR ASR	$266.37
Rate for Payer: ASR Commercial	$266.37
Rate for Payer: BCBS Complete	$109.84
Rate for Payer: BCBS Trust/PPO	$224.88
Rate for Payer: BCN Commercial	$212.91
Rate for Payer: Cash Price	$219.69
Rate for Payer: Cofinity Commercial	$258.13
Rate for Payer: Encore Health Key Benefits Commercial	$219.69
Rate for Payer: Healthscope Commercial	$274.61
Rate for Payer: Healthscope Whirlpool	$266.37
Rate for Payer: Mclaren Commercial	$247.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.42
Rate for Payer: Nomi Health Commercial	$225.18
Rate for Payer: Priority Health Cigna Priority Health	$178.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$240.61
Rate for Payer: Priority Health Narrow Network	$192.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$241.66

VALACYCLOVIR 500 MG TABLET

Facility

$73.53

Service Code	NDC 00378427593
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$73.53
Rate for Payer: Aetna Commercial	$66.18
Rate for Payer: Aetna Medicare	$36.76
Rate for Payer: ASR ASR	$71.32
Rate for Payer: ASR Commercial	$71.32
Rate for Payer: BCBS Complete	$29.41
Rate for Payer: BCBS Trust/PPO	$60.21
Rate for Payer: BCN Commercial	$57.01
Rate for Payer: Cash Price	$58.82
Rate for Payer: Cofinity Commercial	$69.12
Rate for Payer: Encore Health Key Benefits Commercial	$58.82
Rate for Payer: Healthscope Commercial	$73.53
Rate for Payer: Healthscope Whirlpool	$71.32
Rate for Payer: Mclaren Commercial	$66.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.50
Rate for Payer: Nomi Health Commercial	$60.29
Rate for Payer: Priority Health Cigna Priority Health	$47.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.43
Rate for Payer: Priority Health Narrow Network	$51.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.71

VALACYCLOVIR 500 MG TABLET

Facility

$6.15

Service Code	NDC 50268078811
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.15
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: ASR ASR	$5.97
Rate for Payer: ASR Commercial	$5.97
Rate for Payer: BCBS Trust/PPO	$5.01
Rate for Payer: BCN Commercial	$4.77
Rate for Payer: Cash Price	$4.92
Rate for Payer: Cofinity Commercial	$5.78
Rate for Payer: Encore Health Key Benefits Commercial	$4.92
Rate for Payer: Healthscope Commercial	$6.15
Rate for Payer: Healthscope Whirlpool	$5.97
Rate for Payer: Mclaren Commercial	$5.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.23
Rate for Payer: Nomi Health Commercial	$5.04
Rate for Payer: Priority Health Cigna Priority Health	$4.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.41

VALACYCLOVIR 500 MG TABLET

Facility

$76.75

Service Code	NDC 59746032430
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$30.70
Max. Negotiated Rate	$76.75
Rate for Payer: Aetna Commercial	$69.08
Rate for Payer: Aetna Medicare	$38.38
Rate for Payer: ASR ASR	$74.45
Rate for Payer: ASR Commercial	$74.45
Rate for Payer: BCBS Complete	$30.70
Rate for Payer: BCBS Trust/PPO	$62.85
Rate for Payer: BCN Commercial	$59.50
Rate for Payer: Cash Price	$61.40
Rate for Payer: Cofinity Commercial	$72.14
Rate for Payer: Encore Health Key Benefits Commercial	$61.40
Rate for Payer: Healthscope Commercial	$76.75
Rate for Payer: Healthscope Whirlpool	$74.45
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: Priority Health Cigna Priority Health	$49.89
Rate for Payer: 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

$73.53

Service Code	NDC 00378427593
Hospital Charge Code	13133
Hospital Revenue Code	637
Min. Negotiated Rate	$47.79
Max. Negotiated Rate	$73.53
Rate for Payer: Aetna Commercial	$66.18
Rate for Payer: ASR ASR	$71.32
Rate for Payer: ASR Commercial	$71.32
Rate for Payer: BCBS Trust/PPO	$59.92
Rate for Payer: BCN Commercial	$57.01
Rate for Payer: Cash Price	$58.82
Rate for Payer: Cofinity Commercial	$69.12
Rate for Payer: Encore Health Key Benefits Commercial	$58.82
Rate for Payer: Healthscope Commercial	$73.53
Rate for Payer: Healthscope Whirlpool	$71.32
Rate for Payer: Mclaren Commercial	$66.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.50
Rate for Payer: Nomi Health Commercial	$60.29
Rate for Payer: Priority Health Cigna Priority Health	$47.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.71

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.50

Service Code	NDC 00143963710
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: Aetna Medicare	$8.25
Rate for Payer: ASR ASR	$16.00
Rate for Payer: ASR Commercial	$16.00
Rate for Payer: BCBS Complete	$6.60
Rate for Payer: BCBS Trust/PPO	$13.51
Rate for Payer: BCN Commercial	$12.79
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Encore Health Key Benefits Commercial	$13.20
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Healthscope Whirlpool	$16.00
Rate for Payer: Mclaren Commercial	$14.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.02
Rate for Payer: Nomi Health Commercial	$13.53
Rate for Payer: Priority Health Cigna Priority Health	$10.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.46
Rate for Payer: Priority Health Narrow Network	$11.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.52

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.50

Service Code	NDC 00143963701
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: ASR ASR	$16.00
Rate for Payer: ASR Commercial	$16.00
Rate for Payer: BCBS Trust/PPO	$13.45
Rate for Payer: BCN Commercial	$12.79
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Encore Health Key Benefits Commercial	$13.20
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Healthscope Whirlpool	$16.00
Rate for Payer: Mclaren Commercial	$14.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.02
Rate for Payer: Nomi Health Commercial	$13.53
Rate for Payer: Priority Health Cigna Priority Health	$10.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.52

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.50

Service Code	NDC 00143963701
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: Aetna Medicare	$8.25
Rate for Payer: ASR ASR	$16.00
Rate for Payer: ASR Commercial	$16.00
Rate for Payer: BCBS Complete	$6.60
Rate for Payer: BCBS Trust/PPO	$13.51
Rate for Payer: BCN Commercial	$12.79
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Encore Health Key Benefits Commercial	$13.20
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Healthscope Whirlpool	$16.00
Rate for Payer: Mclaren Commercial	$14.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.02
Rate for Payer: Nomi Health Commercial	$13.53
Rate for Payer: Priority Health Cigna Priority Health	$10.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.46
Rate for Payer: Priority Health Narrow Network	$11.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.52

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$16.50

Service Code	NDC 00143963710
Hospital Charge Code	20887
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: ASR ASR	$16.00
Rate for Payer: ASR Commercial	$16.00
Rate for Payer: BCBS Trust/PPO	$13.45
Rate for Payer: BCN Commercial	$12.79
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Encore Health Key Benefits Commercial	$13.20
Rate for Payer: Healthscope Commercial	$16.50
Rate for Payer: Healthscope Whirlpool	$16.00
Rate for Payer: Mclaren Commercial	$14.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.02
Rate for Payer: Nomi Health Commercial	$13.53
Rate for Payer: Priority Health Cigna Priority Health	$10.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.52

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$5.57

Service Code	NDC 00121467505
Hospital Charge Code	150931
Hospital Revenue Code	637
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$5.57
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: Aetna Medicare	$2.78
Rate for Payer: ASR ASR	$5.40
Rate for Payer: ASR Commercial	$5.40
Rate for Payer: BCBS Complete	$2.23
Rate for Payer: BCBS Trust/PPO	$4.56
Rate for Payer: BCN Commercial	$4.32
Rate for Payer: Cash Price	$4.45
Rate for Payer: Cofinity Commercial	$5.24
Rate for Payer: Encore Health Key Benefits Commercial	$4.46
Rate for Payer: Healthscope Commercial	$5.57
Rate for Payer: Healthscope Whirlpool	$5.40
Rate for Payer: Mclaren Commercial	$5.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.73
Rate for Payer: Nomi Health Commercial	$4.57
Rate for Payer: Priority Health Cigna Priority Health	$3.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.88
Rate for Payer: Priority Health Narrow Network	$3.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.90

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$1.76

Service Code	NDC 09900001951
Hospital Charge Code	150931
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.76
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: ASR ASR	$1.71
Rate for Payer: ASR Commercial	$1.71
Rate for Payer: BCBS Trust/PPO	$1.43
Rate for Payer: BCN Commercial	$1.36
Rate for Payer: Cash Price	$1.41
Rate for Payer: Cofinity Commercial	$1.65
Rate for Payer: Encore Health Key Benefits Commercial	$1.41
Rate for Payer: Healthscope Commercial	$1.76
Rate for Payer: Healthscope Whirlpool	$1.71
Rate for Payer: Mclaren Commercial	$1.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.50
Rate for Payer: Nomi Health Commercial	$1.44
Rate for Payer: Priority Health Cigna Priority Health	$1.14
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

$1.76

Service Code	NDC 09900001951
Hospital Charge Code	150931
Hospital Revenue Code	637
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.76
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare	$0.88
Rate for Payer: ASR ASR	$1.71
Rate for Payer: ASR Commercial	$1.71
Rate for Payer: BCBS Complete	$0.70
Rate for Payer: BCBS Trust/PPO	$1.44
Rate for Payer: BCN Commercial	$1.36
Rate for Payer: Cash Price	$1.41
Rate for Payer: Cofinity Commercial	$1.65
Rate for Payer: Encore Health Key Benefits Commercial	$1.41
Rate for Payer: Healthscope Commercial	$1.76
Rate for Payer: Healthscope Whirlpool	$1.71
Rate for Payer: Mclaren Commercial	$1.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.50
Rate for Payer: Nomi Health Commercial	$1.44
Rate for Payer: Priority Health Cigna Priority Health	$1.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1.54
Rate for Payer: Priority Health Narrow Network	$1.23
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

$5.57

Service Code	NDC 00121467505
Hospital Charge Code	150931
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.57
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: ASR ASR	$5.40
Rate for Payer: ASR Commercial	$5.40
Rate for Payer: BCBS Trust/PPO	$4.54
Rate for Payer: BCN Commercial	$4.32
Rate for Payer: Cash Price	$4.45
Rate for Payer: Cofinity Commercial	$5.24
Rate for Payer: Encore Health Key Benefits Commercial	$4.46
Rate for Payer: Healthscope Commercial	$5.57
Rate for Payer: Healthscope Whirlpool	$5.40
Rate for Payer: Mclaren Commercial	$5.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.73
Rate for Payer: Nomi Health Commercial	$4.57
Rate for Payer: Priority Health Cigna Priority Health	$3.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.90

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION

Facility

$355.70

Service Code	NDC 00121067585
Hospital Charge Code	8428
Hospital Revenue Code	637
Min. Negotiated Rate	$142.28
Max. Negotiated Rate	$355.70
Rate for Payer: Aetna Commercial	$320.13
Rate for Payer: Aetna Medicare	$177.85
Rate for Payer: ASR ASR	$345.03
Rate for Payer: ASR Commercial	$345.03
Rate for Payer: BCBS Complete	$142.28
Rate for Payer: BCBS Trust/PPO	$291.28
Rate for Payer: BCN Commercial	$275.77
Rate for Payer: Cash Price	$284.56
Rate for Payer: Cofinity Commercial	$334.36
Rate for Payer: Encore Health Key Benefits Commercial	$284.56
Rate for Payer: Healthscope Commercial	$355.70
Rate for Payer: Healthscope Whirlpool	$345.03
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: Priority Health Cigna Priority Health	$231.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$311.66
Rate for Payer: Priority Health Narrow Network	$249.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$313.02

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION

Facility

$355.70

Service Code	NDC 00121067585
Hospital Charge Code	8428
Hospital Revenue Code	637
Min. Negotiated Rate	$231.20
Max. Negotiated Rate	$355.70
Rate for Payer: Aetna Commercial	$320.13
Rate for Payer: ASR ASR	$345.03
Rate for Payer: ASR Commercial	$345.03
Rate for Payer: BCBS Trust/PPO	$289.86
Rate for Payer: BCN Commercial	$275.77
Rate for Payer: Cash Price	$284.56
Rate for Payer: Cofinity Commercial	$334.36
Rate for Payer: Encore Health Key Benefits Commercial	$284.56
Rate for Payer: Healthscope Commercial	$355.70
Rate for Payer: Healthscope Whirlpool	$345.03
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: Priority Health Cigna Priority Health	$231.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$313.02

VALSARTAN 80 MG TABLET

Facility

$410.31

Service Code	NDC 65862057190
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$164.12
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$369.28
Rate for Payer: Aetna Medicare	$205.16
Rate for Payer: ASR ASR	$398.00
Rate for Payer: ASR Commercial	$398.00
Rate for Payer: BCBS Complete	$164.12
Rate for Payer: BCBS Trust/PPO	$336.00
Rate for Payer: BCN Commercial	$318.11
Rate for Payer: Cash Price	$328.25
Rate for Payer: Cofinity Commercial	$385.69
Rate for Payer: Encore Health Key Benefits Commercial	$328.25
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Healthscope Whirlpool	$398.00
Rate for Payer: Mclaren Commercial	$369.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.76
Rate for Payer: Nomi Health Commercial	$336.45
Rate for Payer: Priority Health Cigna Priority Health	$266.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$359.51
Rate for Payer: Priority Health Narrow Network	$287.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$361.07

VALSARTAN 80 MG TABLET

Facility

$4.78

Service Code	NDC 60687062311
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$4.30
Rate for Payer: Aetna Medicare	$2.39
Rate for Payer: ASR ASR	$4.64
Rate for Payer: ASR Commercial	$4.64
Rate for Payer: BCBS Complete	$1.91
Rate for Payer: BCBS Trust/PPO	$3.91
Rate for Payer: BCN Commercial	$3.71
Rate for Payer: Cash Price	$3.82
Rate for Payer: Cofinity Commercial	$4.49
Rate for Payer: Encore Health Key Benefits Commercial	$3.82
Rate for Payer: Healthscope Commercial	$4.78
Rate for Payer: Healthscope Whirlpool	$4.64
Rate for Payer: Mclaren Commercial	$4.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.06
Rate for Payer: Nomi Health Commercial	$3.92
Rate for Payer: Priority Health Cigna Priority Health	$3.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.19
Rate for Payer: Priority Health Narrow Network	$3.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.21

VALSARTAN 80 MG TABLET

Facility

$4.78

Service Code	NDC 60687062311
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$4.30
Rate for Payer: ASR ASR	$4.64
Rate for Payer: ASR Commercial	$4.64
Rate for Payer: BCBS Trust/PPO	$3.90
Rate for Payer: BCN Commercial	$3.71
Rate for Payer: Cash Price	$3.82
Rate for Payer: Cofinity Commercial	$4.49
Rate for Payer: Encore Health Key Benefits Commercial	$3.82
Rate for Payer: Healthscope Commercial	$4.78
Rate for Payer: Healthscope Whirlpool	$4.64
Rate for Payer: Mclaren Commercial	$4.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.06
Rate for Payer: Nomi Health Commercial	$3.92
Rate for Payer: Priority Health Cigna Priority Health	$3.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.21

VALSARTAN 80 MG TABLET

Facility

$2,862.80

Service Code	NDC 00078035834
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$1,145.12
Max. Negotiated Rate	$2,862.80
Rate for Payer: Aetna Commercial	$2,576.52
Rate for Payer: Aetna Medicare	$1,431.40
Rate for Payer: ASR ASR	$2,776.92
Rate for Payer: ASR Commercial	$2,776.92
Rate for Payer: BCBS Complete	$1,145.12
Rate for Payer: BCBS Trust/PPO	$2,344.35
Rate for Payer: BCN Commercial	$2,219.53
Rate for Payer: Cash Price	$2,290.24
Rate for Payer: Cofinity Commercial	$2,691.03
Rate for Payer: Encore Health Key Benefits Commercial	$2,290.24
Rate for Payer: Healthscope Commercial	$2,862.80
Rate for Payer: Healthscope Whirlpool	$2,776.92
Rate for Payer: Mclaren Commercial	$2,576.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,433.38
Rate for Payer: Nomi Health Commercial	$2,347.50
Rate for Payer: Priority Health Cigna Priority Health	$1,860.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,508.39
Rate for Payer: Priority Health Narrow Network	$2,006.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,519.26

VALSARTAN 80 MG TABLET

Facility

$420.88

Service Code	NDC 43547036809
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$168.35
Max. Negotiated Rate	$420.88
Rate for Payer: Aetna Commercial	$378.79
Rate for Payer: Aetna Medicare	$210.44
Rate for Payer: ASR ASR	$408.25
Rate for Payer: ASR Commercial	$408.25
Rate for Payer: BCBS Complete	$168.35
Rate for Payer: BCBS Trust/PPO	$344.66
Rate for Payer: BCN Commercial	$326.31
Rate for Payer: Cash Price	$336.71
Rate for Payer: Cofinity Commercial	$395.63
Rate for Payer: Encore Health Key Benefits Commercial	$336.70
Rate for Payer: Healthscope Commercial	$420.88
Rate for Payer: Healthscope Whirlpool	$408.25
Rate for Payer: Mclaren Commercial	$378.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.75
Rate for Payer: Nomi Health Commercial	$345.12
Rate for Payer: Priority Health Cigna Priority Health	$273.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$368.78
Rate for Payer: Priority Health Narrow Network	$295.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.37

VALSARTAN 80 MG TABLET

Facility

$410.31

Service Code	NDC 65862057190
Hospital Charge Code	31209
Hospital Revenue Code	637
Min. Negotiated Rate	$266.70
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$369.28
Rate for Payer: ASR ASR	$398.00
Rate for Payer: ASR Commercial	$398.00
Rate for Payer: BCBS Trust/PPO	$334.36
Rate for Payer: BCN Commercial	$318.11
Rate for Payer: Cash Price	$328.25
Rate for Payer: Cofinity Commercial	$385.69
Rate for Payer: Encore Health Key Benefits Commercial	$328.25
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Healthscope Whirlpool	$398.00
Rate for Payer: Mclaren Commercial	$369.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.76
Rate for Payer: Nomi Health Commercial	$336.45
Rate for Payer: Priority Health Cigna Priority Health	$266.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$361.07

Know your out-of-pocket cost for care.

All Charges