|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,437.09 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$718.55 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
|
|
CARIPRAZINE 4.5 MG CAPSULE
|
Facility
|
OP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874014530
|
| Hospital Charge Code |
177104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,155.63 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna Medicare |
$2,742.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: BCBS Complete |
$2,194.03
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,388.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,565.30
|
| Rate for Payer: UHC Core |
$2,857.72
|
| Rate for Payer: UHC Exchange |
$2,155.63
|
|
|
CARIPRAZINE 4.5 MG CAPSULE
|
Facility
|
IP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874014530
|
| Hospital Charge Code |
177104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,455.59 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$40,006.61
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$18,100.64 |
| Max. Negotiated Rate |
$40,006.61 |
| Rate for Payer: Aetna Medicare |
$19,815.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,816.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,816.64
|
| Rate for Payer: BCBS MAPPO |
$19,053.31
|
| Rate for Payer: BCBS Trust/PPO |
$40,006.61
|
| Rate for Payer: BCN Commercial |
$40,006.61
|
| Rate for Payer: BCN Medicare Advantage |
$19,053.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,053.31
|
| Rate for Payer: Mclaren Medicare |
$19,053.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,005.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,911.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,958.64
|
| Rate for Payer: Nomi Health Commercial |
$30,837.45
|
| Rate for Payer: PACE Medicare |
$18,100.64
|
| Rate for Payer: PACE SWMI |
$19,053.31
|
| Rate for Payer: PHP Medicare Advantage |
$19,053.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,539.98
|
| Rate for Payer: Priority Health Medicare |
$19,053.31
|
| Rate for Payer: Priority Health Tiered Network |
$30,831.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,053.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,965.15
|
| Rate for Payer: UHC Core |
$32,599.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,053.31
|
| Rate for Payer: UHC Exchange |
$26,623.00
|
| Rate for Payer: VA VA |
$19,053.31
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,092.41
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$28,968.01 |
| Max. Negotiated Rate |
$63,092.41 |
| Rate for Payer: Aetna Medicare |
$31,712.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,115.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,115.80
|
| Rate for Payer: BCBS MAPPO |
$30,492.64
|
| Rate for Payer: BCBS Trust/PPO |
$62,497.02
|
| Rate for Payer: BCN Commercial |
$62,497.02
|
| Rate for Payer: BCN Medicare Advantage |
$30,492.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,492.64
|
| Rate for Payer: Mclaren Medicare |
$30,492.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,017.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,066.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,541.90
|
| Rate for Payer: Nomi Health Commercial |
$49,932.03
|
| Rate for Payer: PACE Medicare |
$28,968.01
|
| Rate for Payer: PACE SWMI |
$30,492.64
|
| Rate for Payer: PHP Medicare Advantage |
$30,492.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,403.97
|
| Rate for Payer: Priority Health Medicare |
$30,492.64
|
| Rate for Payer: Priority Health Tiered Network |
$49,923.17
|
| Rate for Payer: Railroad Medicare Medicare |
$30,492.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63,092.41
|
| Rate for Payer: UHC Core |
$52,784.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,492.64
|
| Rate for Payer: UHC Exchange |
$43,107.99
|
| Rate for Payer: VA VA |
$30,492.64
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,667.64
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$14,813.72 |
| Max. Negotiated Rate |
$31,667.64 |
| Rate for Payer: Aetna Medicare |
$16,217.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,491.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,491.74
|
| Rate for Payer: BCBS MAPPO |
$15,593.39
|
| Rate for Payer: BCBS Trust/PPO |
$29,545.58
|
| Rate for Payer: BCN Commercial |
$29,545.58
|
| Rate for Payer: BCN Medicare Advantage |
$15,593.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,593.39
|
| Rate for Payer: Mclaren Medicare |
$15,593.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,373.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,932.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,152.73
|
| Rate for Payer: Nomi Health Commercial |
$25,062.12
|
| Rate for Payer: PACE Medicare |
$14,813.72
|
| Rate for Payer: PACE SWMI |
$15,593.39
|
| Rate for Payer: PHP Medicare Advantage |
$15,593.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,322.09
|
| Rate for Payer: Priority Health Medicare |
$15,593.39
|
| Rate for Payer: Priority Health Tiered Network |
$25,057.67
|
| Rate for Payer: Railroad Medicare Medicare |
$15,593.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,667.64
|
| Rate for Payer: UHC Core |
$26,493.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,593.39
|
| Rate for Payer: UHC Exchange |
$21,636.96
|
| Rate for Payer: VA VA |
$15,593.39
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$75.20
|
|
|
Service Code
|
NDC 72888003601
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: BCBS Complete |
$30.08
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.88
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Exchange |
$29.55
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$204.45
|
|
|
Service Code
|
NDC 51079093120
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.35 |
| 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 Advantage |
$143.12
|
| Rate for Payer: Cofinity Commercial |
$175.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health SBD |
$128.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.89
|
| Rate for Payer: UHC Core |
$106.52
|
| Rate for Payer: UHC Exchange |
$80.35
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| 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: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.11 |
| 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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.62
|
| Rate for Payer: UHC Core |
$94.27
|
| Rate for Payer: UHC Exchange |
$71.11
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$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 Advantage |
$143.12
|
| Rate for Payer: Cofinity Commercial |
$175.83
|
| 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: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health SBD |
$128.80
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$75.20
|
|
|
Service Code
|
NDC 72888003601
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.88
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cofinity Advantage |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$64.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.40
|
| Rate for Payer: PHP Commercial |
$63.92
|
| Rate for Payer: Priority Health SBD |
$47.38
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 72888003701
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Advantage |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.94
|
| Rate for Payer: UHC Core |
$41.63
|
| Rate for Payer: UHC Exchange |
$31.40
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| 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: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 72888003701
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Advantage |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health SBD |
$50.34
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00904730861
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630361
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.11 |
| 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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.62
|
| Rate for Payer: UHC Core |
$94.27
|
| Rate for Payer: UHC Exchange |
$71.11
|
|
|
CARVEDILOL 25 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 00904730861
|
| Hospital Charge Code |
15748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 72888003401
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079077101
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Advantage |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.17
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.11 |
| 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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.62
|
| Rate for Payer: UHC Core |
$94.27
|
| Rate for Payer: UHC Exchange |
$71.11
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00904730561
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 72888003401
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.72
|
| Rate for Payer: UHC Core |
$31.83
|
| Rate for Payer: UHC Exchange |
$24.01
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 43547025410
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$110.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.59
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Advantage |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health SBD |
$139.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.59
|
| Rate for Payer: UHC Core |
$115.09
|
| Rate for Payer: UHC Exchange |
$86.81
|
|
