|
CARBAMAZEPINE 200 MG TABLET
|
Facility
IP
|
$252.48
|
|
|
Service Code
|
NDC 68084-444-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.99 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: BCBS Trust/PPO |
$195.12
|
| Rate for Payer: BCN Commercial |
$195.12
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.18
|
| Rate for Payer: UHC Core |
$210.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.36
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079-385-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
IP
|
$2.53
|
|
|
Service Code
|
NDC 68084-444-11
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna Commercial |
$2.15
|
| Rate for Payer: BCBS Trust/PPO |
$1.96
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.90
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
IP
|
$326.65
|
|
|
Service Code
|
NDC 75834-221-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$252.44
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$10.65
|
|
|
Service Code
|
NDC 60687-583-11
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.23
|
| Rate for Payer: BCN Commercial |
$8.23
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.37
|
| Rate for Payer: UHC Core |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$401.76
|
|
|
Service Code
|
NDC 51672-4124-1
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.03 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: BCBS Trust/PPO |
$310.48
|
| Rate for Payer: BCN Commercial |
$310.48
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.50
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.55
|
| Rate for Payer: UHC Core |
$335.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$319.46
|
|
|
Service Code
|
NDC 60687-583-21
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$271.54
|
| Rate for Payer: BCBS Trust/PPO |
$246.88
|
| Rate for Payer: BCN Commercial |
$246.88
|
| Rate for Payer: Cash Price |
$255.57
|
| Rate for Payer: Cofinity Commercial |
$274.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.57
|
| Rate for Payer: Healthscope Commercial |
$287.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$271.54
|
| Rate for Payer: PHP Commercial |
$271.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.12
|
| Rate for Payer: UHC Core |
$266.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.60
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$346.55
|
|
|
Service Code
|
NDC 68084-561-21
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$267.81
|
| Rate for Payer: BCN Commercial |
$267.81
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.57
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
IP
|
$346.55
|
|
|
Service Code
|
NDC 68084-561-11
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$267.81
|
| Rate for Payer: BCN Commercial |
$267.81
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Healthscope Commercial |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.57
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
IP
|
$10.33
|
|
|
Service Code
|
NDC 2355807650
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.98
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
IP
|
$22.75
|
|
|
Service Code
|
NDC 7811273623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.58
|
| Rate for Payer: BCN Commercial |
$17.58
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.34
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
IP
|
$9.79
|
|
|
Service Code
|
NDC 23558-76501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$7.57
|
| Rate for Payer: BCN Commercial |
$7.57
|
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.32
|
| Rate for Payer: PHP Commercial |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.62
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
IP
|
$9.27
|
|
|
Service Code
|
NDC 0904-6627-35
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCN Commercial |
$7.16
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Commercial |
$7.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$8.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.88
|
| Rate for Payer: PHP Commercial |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.16
|
| Rate for Payer: UHC Core |
$7.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.95
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
IP
|
$195.05
|
|
|
Service Code
|
NDC 50228-457-01
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$150.73
|
| Rate for Payer: BCN Commercial |
$150.73
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
IP
|
$425.35
|
|
|
Service Code
|
NDC 63739-107-10
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.42 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: BCBS Trust/PPO |
$328.71
|
| Rate for Payer: BCN Commercial |
$328.71
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.31
|
| Rate for Payer: UHC Core |
$355.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
IP
|
$230.85
|
|
|
Service Code
|
NDC 0378-0078-01
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$178.40
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
NDC 0904-6237-61
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.66 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$254.25
|
| Rate for Payer: BCN Commercial |
$254.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
IP
|
$350.15
|
|
|
Service Code
|
NDC 0904-7257-61
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.56 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: BCBS Trust/PPO |
$270.60
|
| Rate for Payer: BCN Commercial |
$270.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.13
|
| Rate for Payer: UHC Core |
$292.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
IP
|
$200.45
|
|
|
Service Code
|
NDC 0904-6238-61
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.25 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$154.91
|
| Rate for Payer: BCN Commercial |
$154.91
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$308.64
|
|
|
Service Code
|
NDC 0378-0088-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$277.78 |
| Rate for Payer: Aetna Commercial |
$262.34
|
| Rate for Payer: BCBS Trust/PPO |
$238.52
|
| Rate for Payer: BCN Commercial |
$238.52
|
| Rate for Payer: Cash Price |
$246.91
|
| Rate for Payer: Cofinity Commercial |
$265.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.91
|
| Rate for Payer: Healthscope Commercial |
$277.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.34
|
| Rate for Payer: PHP Commercial |
$262.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.60
|
| Rate for Payer: UHC Core |
$257.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.48
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$267.90
|
|
|
Service Code
|
NDC 51079-978-20
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.39 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: BCBS Trust/PPO |
$207.03
|
| Rate for Payer: BCN Commercial |
$207.03
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.75
|
| Rate for Payer: UHC Core |
$223.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
NDC 68084-281-11
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.87
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$2.68
|
|
|
Service Code
|
NDC 51079-978-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$331.55
|
|
|
Service Code
|
NDC 62756-461-88
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.21 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: BCBS Trust/PPO |
$256.22
|
| Rate for Payer: BCN Commercial |
$256.22
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.76
|
| Rate for Payer: UHC Core |
$276.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$337.44
|
|
|
Service Code
|
NDC 68084-281-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna Commercial |
$286.82
|
| Rate for Payer: BCBS Trust/PPO |
$260.77
|
| Rate for Payer: BCN Commercial |
$260.77
|
| Rate for Payer: Cash Price |
$269.95
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.95
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.82
|
| Rate for Payer: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.95
|
| Rate for Payer: UHC Core |
$281.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.08
|
|
