Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION

Facility

$15,880.42

Service Code	HCPCS J9047
Hospital Charge Code	161768
Hospital Revenue Code	636
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$14,292.38
Rate for Payer: Aetna Commercial	$13,498.36
Rate for Payer: Aetna Medicare	$57.88
Rate for Payer: Aetna New Business (MI Preferred)	$10,322.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$69.56
Rate for Payer: Amish Plain Church Group Commercial	$69.56
Rate for Payer: BCBS Complete	$31.32
Rate for Payer: BCBS MAPPO	$55.65
Rate for Payer: BCN Medicare Advantage	$55.65
Rate for Payer: Cash Price	$12,704.34
Rate for Payer: Cash Price	$12,704.34
Rate for Payer: Cofinity Commercial	$13,657.16
Rate for Payer: Cofinity Commercial	$11,116.29
Rate for Payer: Cofinity Medicare Advantage	$11,116.29
Rate for Payer: Encore Health Key Benefits Commercial	$12,704.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$55.65
Rate for Payer: Healthscope Commercial	$14,292.38
Rate for Payer: Mclaren Medicaid	$29.83
Rate for Payer: Mclaren Medicare	$55.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$58.43
Rate for Payer: Meridian Medicaid	$31.32
Rate for Payer: MI Amish Medical Board Commercial	$64.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13,498.36
Rate for Payer: PACE Medicare	$52.87
Rate for Payer: PACE SWMI	$55.65
Rate for Payer: PHP Commercial	$13,498.36
Rate for Payer: PHP Medicare Advantage	$55.65
Rate for Payer: Priority Health Choice Medicaid	$29.83
Rate for Payer: Priority Health Cigna Priority Health	$10,322.27
Rate for Payer: Priority Health Medicare	$55.65
Rate for Payer: Priority Health SBD	$10,004.66
Rate for Payer: Railroad Medicare Medicare	$55.65
Rate for Payer: UHC All Payor (Choice/PPO)	$156.65
Rate for Payer: UHC Dual Complete DSNP	$55.65
Rate for Payer: UHC Medicare Advantage	$55.65
Rate for Payer: UHCCP Medicaid	$31.33
Rate for Payer: VA VA	$55.65

CARIPRAZINE 1.5 MG CAPSULE

Facility

$3,482.59

Service Code	NDC 61874011520
Hospital Charge Code	177102
Hospital Revenue Code	637
Min. Negotiated Rate	$2,194.03
Max. Negotiated Rate	$3,134.33
Rate for Payer: Aetna Commercial	$2,960.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,263.68
Rate for Payer: Cash Price	$2,786.07
Rate for Payer: Cofinity Commercial	$2,437.81
Rate for Payer: Cofinity Commercial	$2,995.03
Rate for Payer: Cofinity Medicare Advantage	$2,437.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,786.07
Rate for Payer: Healthscope Commercial	$3,134.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,960.20
Rate for Payer: PHP Commercial	$2,960.20
Rate for Payer: Priority Health Cigna Priority Health	$2,263.68
Rate for Payer: Priority Health SBD	$2,194.03

CARIPRAZINE 1.5 MG CAPSULE

Facility

$1,741.30

Service Code	NDC 61874011511
Hospital Charge Code	177102
Hospital Revenue Code	637
Min. Negotiated Rate	$696.52
Max. Negotiated Rate	$1,567.17
Rate for Payer: Aetna Commercial	$1,480.11
Rate for Payer: Aetna Medicare	$870.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,131.85
Rate for Payer: BCBS Complete	$696.52
Rate for Payer: Cash Price	$1,393.04
Rate for Payer: Cofinity Commercial	$1,218.91
Rate for Payer: Cofinity Commercial	$1,497.52
Rate for Payer: Cofinity Medicare Advantage	$1,218.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,393.04
Rate for Payer: Healthscope Commercial	$1,567.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,480.11
Rate for Payer: PHP Commercial	$1,480.11
Rate for Payer: Priority Health Cigna Priority Health	$1,131.85
Rate for Payer: Priority Health SBD	$1,097.02

CARIPRAZINE 1.5 MG CAPSULE

Facility

$1,741.30

Service Code	NDC 61874011511
Hospital Charge Code	177102
Hospital Revenue Code	637
Min. Negotiated Rate	$1,097.02
Max. Negotiated Rate	$1,567.17
Rate for Payer: Aetna Commercial	$1,480.11
Rate for Payer: Aetna New Business (MI Preferred)	$1,131.85
Rate for Payer: Cash Price	$1,393.04
Rate for Payer: Cofinity Commercial	$1,218.91
Rate for Payer: Cofinity Commercial	$1,497.52
Rate for Payer: Cofinity Medicare Advantage	$1,218.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,393.04
Rate for Payer: Healthscope Commercial	$1,567.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,480.11
Rate for Payer: PHP Commercial	$1,480.11
Rate for Payer: Priority Health Cigna Priority Health	$1,131.85
Rate for Payer: Priority Health SBD	$1,097.02

CARIPRAZINE 1.5 MG CAPSULE

Facility

$3,482.59

Service Code	NDC 61874011520
Hospital Charge Code	177102
Hospital Revenue Code	637
Min. Negotiated Rate	$1,393.04
Max. Negotiated Rate	$3,134.33
Rate for Payer: Aetna Commercial	$2,960.20
Rate for Payer: Aetna Medicare	$1,741.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,263.68
Rate for Payer: BCBS Complete	$1,393.04
Rate for Payer: Cash Price	$2,786.07
Rate for Payer: Cofinity Commercial	$2,437.81
Rate for Payer: Cofinity Commercial	$2,995.03
Rate for Payer: Cofinity Medicare Advantage	$2,437.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,786.07
Rate for Payer: Healthscope Commercial	$3,134.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,960.20
Rate for Payer: PHP Commercial	$2,960.20
Rate for Payer: Priority Health Cigna Priority Health	$2,263.68
Rate for Payer: Priority Health SBD	$2,194.03

CARIPRAZINE 3 MG CAPSULE

Facility

$5,223.89

Service Code	NDC 61874013030
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$3,291.05
Max. Negotiated Rate	$4,701.50
Rate for Payer: Aetna Commercial	$4,440.31
Rate for Payer: Aetna New Business (MI Preferred)	$3,395.53
Rate for Payer: Cash Price	$4,179.11
Rate for Payer: Cofinity Commercial	$3,656.72
Rate for Payer: Cofinity Commercial	$4,492.55
Rate for Payer: Cofinity Medicare Advantage	$3,656.72
Rate for Payer: Encore Health Key Benefits Commercial	$4,179.11
Rate for Payer: Healthscope Commercial	$4,701.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,440.31
Rate for Payer: PHP Commercial	$4,440.31
Rate for Payer: Priority Health Cigna Priority Health	$3,395.53
Rate for Payer: Priority Health SBD	$3,291.05

CARIPRAZINE 3 MG CAPSULE

Facility

$1,741.30

Service Code	NDC 61874013011
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$696.52
Max. Negotiated Rate	$1,567.17
Rate for Payer: Aetna Commercial	$1,480.11
Rate for Payer: Aetna Medicare	$870.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,131.85
Rate for Payer: BCBS Complete	$696.52
Rate for Payer: Cash Price	$1,393.04
Rate for Payer: Cofinity Commercial	$1,218.91
Rate for Payer: Cofinity Commercial	$1,497.52
Rate for Payer: Cofinity Medicare Advantage	$1,218.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,393.04
Rate for Payer: Healthscope Commercial	$1,567.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,480.11
Rate for Payer: PHP Commercial	$1,480.11
Rate for Payer: Priority Health Cigna Priority Health	$1,131.85
Rate for Payer: Priority Health SBD	$1,097.02

CARIPRAZINE 3 MG CAPSULE

Facility

$1,741.30

Service Code	NDC 61874013011
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$1,097.02
Max. Negotiated Rate	$1,567.17
Rate for Payer: Aetna Commercial	$1,480.11
Rate for Payer: Aetna New Business (MI Preferred)	$1,131.85
Rate for Payer: Cash Price	$1,393.04
Rate for Payer: Cofinity Commercial	$1,218.91
Rate for Payer: Cofinity Commercial	$1,497.52
Rate for Payer: Cofinity Medicare Advantage	$1,218.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,393.04
Rate for Payer: Healthscope Commercial	$1,567.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,480.11
Rate for Payer: PHP Commercial	$1,480.11
Rate for Payer: Priority Health Cigna Priority Health	$1,131.85
Rate for Payer: Priority Health SBD	$1,097.02

CARIPRAZINE 3 MG CAPSULE

Facility

$3,482.59

Service Code	NDC 61874013020
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$2,194.03
Max. Negotiated Rate	$3,134.33
Rate for Payer: Aetna Commercial	$2,960.20
Rate for Payer: Aetna New Business (MI Preferred)	$2,263.68
Rate for Payer: Cash Price	$2,786.07
Rate for Payer: Cofinity Commercial	$2,437.81
Rate for Payer: Cofinity Commercial	$2,995.03
Rate for Payer: Cofinity Medicare Advantage	$2,437.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,786.07
Rate for Payer: Healthscope Commercial	$3,134.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,960.20
Rate for Payer: PHP Commercial	$2,960.20
Rate for Payer: Priority Health Cigna Priority Health	$2,263.68
Rate for Payer: Priority Health SBD	$2,194.03

CARIPRAZINE 3 MG CAPSULE

Facility

$5,223.89

Service Code	NDC 61874013030
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$2,089.56
Max. Negotiated Rate	$4,701.50
Rate for Payer: Aetna Commercial	$4,440.31
Rate for Payer: Aetna Medicare	$2,611.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,395.53
Rate for Payer: BCBS Complete	$2,089.56
Rate for Payer: Cash Price	$4,179.11
Rate for Payer: Cofinity Commercial	$3,656.72
Rate for Payer: Cofinity Commercial	$4,492.55
Rate for Payer: Cofinity Medicare Advantage	$3,656.72
Rate for Payer: Encore Health Key Benefits Commercial	$4,179.11
Rate for Payer: Healthscope Commercial	$4,701.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,440.31
Rate for Payer: PHP Commercial	$4,440.31
Rate for Payer: Priority Health Cigna Priority Health	$3,395.53
Rate for Payer: Priority Health SBD	$3,291.05

CARIPRAZINE 3 MG CAPSULE

Facility

$3,482.59

Service Code	NDC 61874013020
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$1,393.04
Max. Negotiated Rate	$3,134.33
Rate for Payer: Aetna Commercial	$2,960.20
Rate for Payer: Aetna Medicare	$1,741.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,263.68
Rate for Payer: BCBS Complete	$1,393.04
Rate for Payer: Cash Price	$2,786.07
Rate for Payer: Cofinity Commercial	$2,437.81
Rate for Payer: Cofinity Commercial	$2,995.03
Rate for Payer: Cofinity Medicare Advantage	$2,437.81
Rate for Payer: Encore Health Key Benefits Commercial	$2,786.07
Rate for Payer: Healthscope Commercial	$3,134.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,960.20
Rate for Payer: PHP Commercial	$2,960.20
Rate for Payer: Priority Health Cigna Priority Health	$2,263.68
Rate for Payer: Priority Health SBD	$2,194.03

CARIPRAZINE 4.5 MG CAPSULE

Facility

$5,223.89

Service Code	NDC 61874014530
Hospital Charge Code	177104
Hospital Revenue Code	637
Min. Negotiated Rate	$3,291.05
Max. Negotiated Rate	$4,701.50
Rate for Payer: Aetna Commercial	$4,440.31
Rate for Payer: Aetna New Business (MI Preferred)	$3,395.53
Rate for Payer: Cash Price	$4,179.11
Rate for Payer: Cofinity Commercial	$3,656.72
Rate for Payer: Cofinity Commercial	$4,492.55
Rate for Payer: Cofinity Medicare Advantage	$3,656.72
Rate for Payer: Encore Health Key Benefits Commercial	$4,179.11
Rate for Payer: Healthscope Commercial	$4,701.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,440.31
Rate for Payer: PHP Commercial	$4,440.31
Rate for Payer: Priority Health Cigna Priority Health	$3,395.53
Rate for Payer: Priority Health SBD	$3,291.05

CARIPRAZINE 4.5 MG CAPSULE

Facility

$5,223.89

Service Code	NDC 61874014530
Hospital Charge Code	177104
Hospital Revenue Code	637
Min. Negotiated Rate	$2,089.56
Max. Negotiated Rate	$4,701.50
Rate for Payer: Aetna Commercial	$4,440.31
Rate for Payer: Aetna Medicare	$2,611.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,395.53
Rate for Payer: BCBS Complete	$2,089.56
Rate for Payer: Cash Price	$4,179.11
Rate for Payer: Cofinity Commercial	$3,656.72
Rate for Payer: Cofinity Commercial	$4,492.55
Rate for Payer: Cofinity Medicare Advantage	$3,656.72
Rate for Payer: Encore Health Key Benefits Commercial	$4,179.11
Rate for Payer: Healthscope Commercial	$4,701.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,440.31
Rate for Payer: PHP Commercial	$4,440.31
Rate for Payer: Priority Health Cigna Priority Health	$3,395.53
Rate for Payer: Priority Health SBD	$3,291.05

CARVEDILOL 12.5 MG TABLET

Facility

$204.45

Service Code	NDC 51079093120
Hospital Charge Code	15749
Hospital Revenue Code	637
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

CARVEDILOL 12.5 MG TABLET

Facility

$180.95

Service Code	NDC 00904630261
Hospital Charge Code	15749
Hospital Revenue Code	637
Min. Negotiated Rate	$72.38
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna Medicare	$90.47
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: BCBS Complete	$72.38
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 12.5 MG TABLET

Facility

$204.45

Service Code	NDC 51079093120
Hospital Charge Code	15749
Hospital Revenue Code	637
Min. Negotiated Rate	$81.78
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna Medicare	$102.22
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: BCBS Complete	$81.78
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

CARVEDILOL 12.5 MG TABLET

Facility

$180.95

Service Code	NDC 00904630261
Hospital Charge Code	15749
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 25 MG TABLET

Facility

$180.95

Service Code	NDC 00904630361
Hospital Charge Code	15748
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 25 MG TABLET

Facility

$180.95

Service Code	NDC 00904630361
Hospital Charge Code	15748
Hospital Revenue Code	637
Min. Negotiated Rate	$72.38
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna Medicare	$90.47
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: BCBS Complete	$72.38
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 3.125 MG TABLET

Facility

$185.65

Service Code	NDC 51079077120
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$116.96
Max. Negotiated Rate	$167.09
Rate for Payer: Aetna Commercial	$157.80
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: Cash Price	$148.52
Rate for Payer: Cofinity Commercial	$129.96
Rate for Payer: Cofinity Commercial	$159.66
Rate for Payer: Cofinity Medicare Advantage	$129.96
Rate for Payer: Encore Health Key Benefits Commercial	$148.52
Rate for Payer: Healthscope Commercial	$167.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.80
Rate for Payer: PHP Commercial	$157.80
Rate for Payer: Priority Health Cigna Priority Health	$120.67
Rate for Payer: Priority Health SBD	$116.96

CARVEDILOL 3.125 MG TABLET

Facility

$180.95

Service Code	NDC 00904730561
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 3.125 MG TABLET

Facility

$129.25

Service Code	NDC 68462016201
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$116.33
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.47
Rate for Payer: Cofinity Medicare Advantage	$90.47
Rate for Payer: Encore Health Key Benefits Commercial	$103.40
Rate for Payer: Healthscope Commercial	$116.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$84.01
Rate for Payer: Priority Health SBD	$81.43

CARVEDILOL 3.125 MG TABLET

Facility

$129.25

Service Code	NDC 68462016201
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$116.33
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna Medicare	$64.62
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: BCBS Complete	$51.70
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.47
Rate for Payer: Cofinity Medicare Advantage	$90.47
Rate for Payer: Encore Health Key Benefits Commercial	$103.40
Rate for Payer: Healthscope Commercial	$116.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$84.01
Rate for Payer: Priority Health SBD	$81.43

CARVEDILOL 3.125 MG TABLET

Facility

$185.65

Service Code	NDC 51079077120
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$74.26
Max. Negotiated Rate	$167.09
Rate for Payer: Aetna Commercial	$157.80
Rate for Payer: Aetna Medicare	$92.83
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: Cash Price	$148.52
Rate for Payer: Cofinity Commercial	$129.96
Rate for Payer: Cofinity Commercial	$159.66
Rate for Payer: Cofinity Medicare Advantage	$129.96
Rate for Payer: Encore Health Key Benefits Commercial	$148.52
Rate for Payer: Healthscope Commercial	$167.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.80
Rate for Payer: PHP Commercial	$157.80
Rate for Payer: Priority Health Cigna Priority Health	$120.67
Rate for Payer: Priority Health SBD	$116.96

CARVEDILOL 3.125 MG TABLET

Facility

$180.95

Service Code	NDC 00904730561
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$72.38
Max. Negotiated Rate	$162.85
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna Medicare	$90.47
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: BCBS Complete	$72.38
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.67
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Medicare Advantage	$126.67
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$117.62
Rate for Payer: Priority Health SBD	$114.00

Know your out-of-pocket cost for care.

All Charges