|
VALGANCICLOVIR 60 MG/ML ORAL LIQUID - COMPOUNDED [701486]
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 09999701486
|
| Hospital Charge Code |
00591257920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Brighton Health Commercial |
$5.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.15
|
|
|
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: Brighton Health Commercial |
$9.83
|
| 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: Brighton Health Commercial |
$9.83
|
| 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 HCL 450 MG PO TABS [30148]
|
Facility
|
OP
|
$55.59
|
|
|
Service Code
|
NDC 00904679610
|
| Hospital Charge Code |
00904679610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$44.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.80
|
| Rate for Payer: Aetna Government |
$27.80
|
| Rate for Payer: Brighton Health Commercial |
$41.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.80
|
| Rate for Payer: Group Health Inc Commercial |
$27.80
|
| Rate for Payer: Group Health Inc Medicare |
$19.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.13
|
|
|
VALGANCICLOVIR HCL 450 MG PO TABS [30148]
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
NDC 00004003822
|
| Hospital Charge Code |
00004003822
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$84.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.04
|
| Rate for Payer: Aetna Government |
$53.04
|
| Rate for Payer: Brighton Health Commercial |
$79.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.14
|
| Rate for Payer: Group Health Inc Commercial |
$53.04
|
| Rate for Payer: Group Health Inc Medicare |
$37.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.95
|
|
|
VALGANCICLOVIR HCL 450 MG PO TABS [30148]
|
Facility
|
OP
|
$64.40
|
|
|
Service Code
|
NDC 31722083260
|
| Hospital Charge Code |
31722083260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Government |
$32.20
|
| Rate for Payer: Brighton Health Commercial |
$48.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.79
|
| Rate for Payer: Group Health Inc Commercial |
$32.20
|
| Rate for Payer: Group Health Inc Medicare |
$22.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.86
|
|
|
VALGANCICLOVIR HCL 50 MG/ML PO SOLR [99443]
|
Facility
|
OP
|
$14.59
|
|
|
Service Code
|
NDC 00004003909
|
| Hospital Charge Code |
00004003909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$11.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.30
|
| Rate for Payer: Aetna Government |
$7.30
|
| Rate for Payer: Brighton Health Commercial |
$10.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.30
|
| Rate for Payer: Group Health Inc Medicare |
$5.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.49
|
|
|
VALGANCICLOVIR HCL 50 MG/ML PO SOLR [99443]
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 00591257920
|
| Hospital Charge Code |
00591257920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Brighton Health Commercial |
$5.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.15
|
|
|
VALGANCICLOVIR HCL 50 MG/ML PO SOLR [99443]
|
Facility
|
OP
|
$11.37
|
|
|
Service Code
|
NDC 72205001901
|
| Hospital Charge Code |
72205001901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.68
|
| Rate for Payer: Aetna Government |
$5.68
|
| Rate for Payer: Brighton Health Commercial |
$8.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.73
|
| Rate for Payer: Group Health Inc Commercial |
$5.68
|
| Rate for Payer: Group Health Inc Medicare |
$3.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.39
|
|
|
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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$5.12
|
| 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: Brighton Health Commercial |
$5.12
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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: Brighton Health Commercial |
$7.50
|
| 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 100 MG/ML IV SOLN [20887]
|
Facility
|
OP
|
$1.61
|
|
|
Service Code
|
NDC 63323049405
|
| Hospital Charge Code |
63323049405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Brighton Health Commercial |
$0.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.92
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.05
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN [20887]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 63323049416
|
| Hospital Charge Code |
63323049416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN [20887]
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 00143978501
|
| Hospital Charge Code |
00143978501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.07
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN [20887]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 63323049401
|
| Hospital Charge Code |
63323049401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN [20887]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 63323049405
|
| Hospital Charge Code |
63323049405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN [20887]
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 00143978501
|
| Hospital Charge Code |
00143978501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.07
|
| Rate for Payer: Aetna Government |
$2.07
|
| Rate for Payer: Brighton Health Commercial |
$2.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.39
|
| Rate for Payer: EmblemHealth Commercial |
$2.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.36
|
| Rate for Payer: Group Health Inc Commercial |
$2.07
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
