|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 60687066111
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cofinity Advantage |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.56
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PHP Commercial |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.23
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.71
|
| Rate for Payer: UHC Core |
$187.33
|
| Rate for Payer: UHC Exchange |
$141.30
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 60687066111
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.66
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cofinity Advantage |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.56
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PHP Commercial |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.27
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Exchange |
$0.77
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 60687066101
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.59
|
| Rate for Payer: UHC Core |
$101.46
|
| Rate for Payer: UHC Exchange |
$76.54
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 59651045701
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.95 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
NDC 60687083611
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Advantage |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health SBD |
$126.28
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$354.35
|
|
|
Service Code
|
NDC 60687083601
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.24 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Advantage |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.76
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health SBD |
$223.24
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Advantage |
$140.31
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.29
|
| Rate for Payer: UHC Core |
$104.43
|
| Rate for Payer: UHC Exchange |
$78.78
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 60687083611
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Exchange |
$1.40
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$354.35
|
|
|
Service Code
|
NDC 60687083601
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.26 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna Medicare |
$177.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: BCBS Complete |
$141.74
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Advantage |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.76
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.33
|
| Rate for Payer: UHC Core |
$184.62
|
| Rate for Payer: UHC Exchange |
$139.26
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$276.45
|
|
|
Service Code
|
NDC 50228046101
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$248.81 |
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: Aetna Medicare |
$138.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.69
|
| Rate for Payer: BCBS Complete |
$110.58
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Advantage |
$193.51
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.34
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health SBD |
$174.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.69
|
| Rate for Payer: UHC Core |
$144.03
|
| Rate for Payer: UHC Exchange |
$108.64
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$305.28
|
|
|
Service Code
|
NDC 68084028211
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.33 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Advantage |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.96
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$305.28
|
|
|
Service Code
|
NDC 68084028211
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$152.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: BCBS Complete |
$122.11
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Advantage |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.96
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health SBD |
$192.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.43
|
| Rate for Payer: UHC Core |
$159.05
|
| Rate for Payer: UHC Exchange |
$119.98
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$305.28
|
|
|
Service Code
|
NDC 68084028201
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$152.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: BCBS Complete |
$122.11
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Advantage |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.96
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health SBD |
$192.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.43
|
| Rate for Payer: UHC Core |
$159.05
|
| Rate for Payer: UHC Exchange |
$119.98
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$320.16
|
|
|
Service Code
|
NDC 51079092320
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.70 |
| Max. Negotiated Rate |
$288.14 |
| Rate for Payer: Aetna Commercial |
$272.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.13
|
| Rate for Payer: Cofinity Advantage |
$224.11
|
| Rate for Payer: Cofinity Commercial |
$275.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.13
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.12
|
| Rate for Payer: PHP Commercial |
$272.14
|
| Rate for Payer: Priority Health SBD |
$201.70
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$276.45
|
|
|
Service Code
|
NDC 50228046101
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.16 |
| Max. Negotiated Rate |
$248.81 |
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.69
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Advantage |
$193.51
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.34
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health SBD |
$174.16
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
NDC 51079092301
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.09
|
| Rate for Payer: UHC Core |
$1.67
|
| Rate for Payer: UHC Exchange |
$1.26
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.55 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: BCBS Complete |
$250.94
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Advantage |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.52
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health SBD |
$395.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.78
|
| Rate for Payer: UHC Core |
$326.85
|
| Rate for Payer: UHC Exchange |
$246.55
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$320.16
|
|
|
Service Code
|
NDC 51079092320
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$288.14 |
| Rate for Payer: Aetna Commercial |
$272.14
|
| Rate for Payer: Aetna Medicare |
$160.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: Cash Price |
$256.13
|
| Rate for Payer: Cofinity Advantage |
$224.11
|
| Rate for Payer: Cofinity Commercial |
$275.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.13
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.12
|
| Rate for Payer: PHP Commercial |
$272.14
|
| Rate for Payer: Priority Health SBD |
$201.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.10
|
| Rate for Payer: UHC Core |
$166.80
|
| Rate for Payer: UHC Exchange |
$125.82
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.24 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Advantage |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.52
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health SBD |
$395.24
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$305.28
|
|
|
Service Code
|
NDC 68084028201
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.33 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.43
|
| Rate for Payer: Cash Price |
$244.22
|
| Rate for Payer: Cofinity Advantage |
$213.70
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.22
|
| Rate for Payer: Healthscope Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.96
|
| Rate for Payer: PHP Commercial |
$259.49
|
| Rate for Payer: Priority Health SBD |
$192.33
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
NDC 51079092301
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.07
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$313.65
|
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Commercial |
$413.63
|
| Rate for Payer: Aetna Commercial |
$257.19
|
| Rate for Payer: Aetna Commercial |
$256.27
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$151.29
|
| Rate for Payer: Aetna Medicare |
$150.75
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: Aetna Medicare |
$118.41
|
| Rate for Payer: Aetna Medicare |
$128.53
|
| Rate for Payer: Aetna Medicare |
$275.83
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna Medicare |
$240.16
|
| Rate for Payer: Aetna Medicare |
$184.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: BCBS Complete |
$147.60
|
| Rate for Payer: BCBS Complete |
$102.83
|
| Rate for Payer: BCBS Complete |
$94.73
|
| Rate for Payer: BCBS Complete |
$220.67
|
| Rate for Payer: BCBS Complete |
$194.65
|
| Rate for Payer: BCBS Complete |
$121.03
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Complete |
$192.13
|
| Rate for Payer: BCBS Complete |
$120.60
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$242.06
|
| Rate for Payer: Cash Price |
$242.06
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cash Price |
$389.30
|
| Rate for Payer: Cash Price |
$389.30
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cofinity Advantage |
$386.17
|
| Rate for Payer: Cofinity Advantage |
$211.81
|
| Rate for Payer: Cofinity Advantage |
$179.95
|
| Rate for Payer: Cofinity Advantage |
$165.77
|
| Rate for Payer: Cofinity Advantage |
$258.30
|
| Rate for Payer: Cofinity Advantage |
$211.05
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Advantage |
$340.63
|
| Rate for Payer: Cofinity Advantage |
$336.22
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Cofinity Commercial |
$260.22
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$317.34
|
| Rate for Payer: Cofinity Commercial |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Commercial |
$413.08
|
| Rate for Payer: Cofinity Commercial |
$418.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Healthscope Commercial |
$437.96
|
| Rate for Payer: Healthscope Commercial |
$272.32
|
| Rate for Payer: Healthscope Commercial |
$271.35
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Commercial |
$231.36
|
| Rate for Payer: Healthscope Commercial |
$432.29
|
| Rate for Payer: Healthscope Commercial |
$332.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.94
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: PHP Commercial |
$257.19
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: PHP Commercial |
$256.27
|
| Rate for Payer: PHP Commercial |
$408.27
|
| Rate for Payer: PHP Commercial |
$313.65
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$413.63
|
| Rate for Payer: Priority Health SBD |
$306.57
|
| Rate for Payer: Priority Health SBD |
$302.60
|
| Rate for Payer: Priority Health SBD |
$190.63
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: Priority Health SBD |
$232.47
|
| Rate for Payer: Priority Health SBD |
$347.55
|
| Rate for Payer: Priority Health SBD |
$189.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Commercial |
$256.27
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cofinity Advantage |
$211.05
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Advantage |
$386.17
|
| Rate for Payer: Cofinity Commercial |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$271.35
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: PHP Commercial |
$256.27
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: Priority Health SBD |
$189.94
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: Priority Health SBD |
$347.55
|
|
