|
VALGANCICLOVIR 450 MG TAB
|
Facility
IP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41642623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
IP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41652623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
OP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41652623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.75
|
| Rate for Payer: Aetna Government |
$47.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.91
|
| Rate for Payer: Group Health Inc Commercial |
$47.75
|
| Rate for Payer: Group Health Inc Medicare |
$33.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.08
|
|
|
VALGANCICLOVIR 50 MG/ML SUSP
|
Facility
OP
|
$13.14
|
|
| Hospital Charge Code |
41645609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna Government |
$6.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.94
|
| Rate for Payer: Group Health Inc Commercial |
$6.57
|
| Rate for Payer: Group Health Inc Medicare |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.54
|
|
|
VALGANCICLOVIR 50 MG/ML SUSP
|
Facility
OP
|
$13.14
|
|
| Hospital Charge Code |
41655609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna Government |
$6.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.94
|
| Rate for Payer: Group Health Inc Commercial |
$6.57
|
| Rate for Payer: Group Health Inc Medicare |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.54
|
|
|
VALGANCICLOVIR 60MG/ML SUSP
|
Facility
OP
|
$13.11
|
|
| Hospital Charge Code |
41646608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.56
|
| Rate for Payer: Aetna Government |
$6.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.91
|
| Rate for Payer: Group Health Inc Commercial |
$6.56
|
| Rate for Payer: Group Health Inc Medicare |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.52
|
|
|
VALGANCICLOVIR 60MG/ML SUSP
|
Facility
OP
|
$13.11
|
|
| Hospital Charge Code |
41656608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.56
|
| Rate for Payer: Aetna Government |
$6.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.91
|
| Rate for Payer: Group Health Inc Commercial |
$6.56
|
| Rate for Payer: Group Health Inc Medicare |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.52
|
|
|
VALPROATE 1000MG/D5W 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41655895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 1000MG/D5W 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41645895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 1000MG/NS 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41645899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 1000MG/NS 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41655899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 250MG/NS 100ML
|
Facility
OP
|
$6.83
|
|
| Hospital Charge Code |
41653589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.42
|
| Rate for Payer: Aetna Government |
$3.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.64
|
| Rate for Payer: Group Health Inc Commercial |
$3.42
|
| Rate for Payer: Group Health Inc Medicare |
$2.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.44
|
|
|
VALPROATE 250MG/NS 100ML
|
Facility
OP
|
$6.83
|
|
| Hospital Charge Code |
41643589
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.42
|
| Rate for Payer: Aetna Government |
$3.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.64
|
| Rate for Payer: Group Health Inc Commercial |
$3.42
|
| Rate for Payer: Group Health Inc Medicare |
$2.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.44
|
|
|
VALPROATE 750MG/D5W 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41655893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 750MG/D5W 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41645893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 750MG/NS 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41655897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE 750MG/NS 100ML
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41645897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
VALPROATE SODIUM 250MG/5ML SYRUP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VALPROATE SODIUM 250MG/5ML SYRUP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VALPROATE SODIUM 250 MG/5 ML SYRUP 5 ML
|
Facility
OP
|
$0.93
|
|
| Hospital Charge Code |
41653740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
VALPROATE SODIUM 250 MG/5 ML SYRUP 5 ML
|
Facility
OP
|
$0.93
|
|
| Hospital Charge Code |
41643740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
VALPROATE SODIUM 500 MG INJ
|
Facility
OP
|
$4.94
|
|
| Hospital Charge Code |
41642210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna Government |
$2.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$2.47
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.21
|
|
|
VALPROATE SODIUM 500 MG INJ
|
Facility
OP
|
$4.94
|
|
| Hospital Charge Code |
41652210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna Government |
$2.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$2.47
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.21
|
|
|
VALPROIC ACID
|
Facility
OP
|
$33.85
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
40602588
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.54
|
| Rate for Payer: Aetna Government |
$13.54
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.54
|
| Rate for Payer: EmblemHealth Commercial |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$13.54
|
| Rate for Payer: Group Health Inc Medicare |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.54
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.83
|
| Rate for Payer: Wellcare Medicare |
$12.19
|
|
|
VALPROIC ACID 250 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
