|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: Meridian Medicaid |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$5.40
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicaid |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: UHCCP Medicaid |
$4.01
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Commercial |
$8.09
|
| 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 Commercial |
$8.32
|
| Rate for Payer: Nomi Health Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.34
|
| Rate for Payer: PHP Commercial |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.81
|
| 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
|
$10.74
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.87
|
| Rate for Payer: BCN Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$9.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.13
|
| Rate for Payer: Nomi Health Commercial |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.05
|
| Rate for Payer: PHP Commercial |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.45
|
| Rate for Payer: UHC Core |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.05
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 23558007650
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$1.91
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.49
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| 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: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Mclaren Medicaid |
$1.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: Meridian Medicaid |
$1.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.75
|
| Rate for Payer: PACE Senior Care Partners |
$2.45
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.19
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UHC Medicaid |
$1.82
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: UHCCP Medicaid |
$1.82
|
| Rate for Payer: VA VA |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 23558007650
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.53
|
| Rate for Payer: BCN Commercial |
$8.53
|
| 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 Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.75
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.19
|
| 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 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.79
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| 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 Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.83
|
| 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
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: BCBS Trust/PPO |
$18.48
|
| Rate for Payer: BCN Commercial |
$18.48
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.78
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.69
|
| Rate for Payer: UHC Core |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.06
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: BCBS MAPPO |
$2.45
|
| Rate for Payer: BCBS Trust/PPO |
$8.05
|
| Rate for Payer: BCN Commercial |
$8.05
|
| Rate for Payer: BCN Medicare Advantage |
$2.45
|
| 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: Health Alliance Plan Medicare Advantage |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Mclaren Medicaid |
$1.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.57
|
| Rate for Payer: Meridian Medicaid |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.32
|
| Rate for Payer: Nomi Health Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.34
|
| Rate for Payer: PACE Senior Care Partners |
$2.33
|
| Rate for Payer: PACE SWMI |
$2.45
|
| Rate for Payer: PHP Commercial |
$8.32
|
| Rate for Payer: PHP Medicare Advantage |
$2.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.52
|
| Rate for Payer: Priority Health Medicare |
$2.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.62
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: UHC Exchange |
$2.45
|
| Rate for Payer: UHC Medicaid |
$1.73
|
| Rate for Payer: UHC Medicare Advantage |
$2.45
|
| Rate for Payer: UHCCP Medicaid |
$1.73
|
| Rate for Payer: VA VA |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.86
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS MAPPO |
$33.49
|
| Rate for Payer: BCBS Trust/PPO |
$110.12
|
| Rate for Payer: BCN Commercial |
$110.12
|
| Rate for Payer: BCN Medicare Advantage |
$33.49
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.49
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Mclaren Medicaid |
$23.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.16
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PACE Senior Care Partners |
$31.81
|
| Rate for Payer: PACE SWMI |
$33.49
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: PHP Medicare Advantage |
$33.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Medicare |
$33.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.23
|
| Rate for Payer: Railroad Medicare Medicare |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: UHC Exchange |
$33.49
|
| Rate for Payer: UHC Medicaid |
$23.62
|
| Rate for Payer: UHC Medicare Advantage |
$33.49
|
| Rate for Payer: UHCCP Medicaid |
$23.62
|
| Rate for Payer: VA VA |
$33.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00378007801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.67 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$190.66
|
| Rate for Payer: BCN Commercial |
$190.66
|
| 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 Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.67
|
| 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 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: BCBS Trust/PPO |
$110.63
|
| Rate for Payer: BCN Commercial |
$110.63
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00378007801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$42.73
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$189.78
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| 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: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Mclaren Medicaid |
$40.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: Meridian Medicaid |
$42.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicaid |
$40.70
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: UHCCP Medicaid |
$40.70
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
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 |
$1.36 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.56
|
| 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: Lakeland Regional Health Systems Commercial |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.66
|
| Rate for Payer: Nomi Health Commercial |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PHP Commercial |
$1.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.46
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 00904750161
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.04 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: BCBS Trust/PPO |
$351.30
|
| Rate for Payer: BCN Commercial |
$351.30
|
| 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 |
$382.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.04
|
| 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 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 |
$0.34 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.66
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.61
|
| Rate for Payer: BCBS Complete |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cofinity Commercial |
$1.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.49
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.46
|
| Rate for Payer: Mclaren Medicaid |
$0.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: Meridian Medicaid |
$0.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.66
|
| Rate for Payer: Nomi Health Commercial |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PACE Senior Care Partners |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.49
|
| Rate for Payer: PHP Commercial |
$1.66
|
| Rate for Payer: PHP Medicare Advantage |
$0.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.70
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.63
|
| Rate for Payer: UHC Exchange |
$0.49
|
| Rate for Payer: UHC Medicaid |
$0.34
|
| Rate for Payer: UHC Medicare Advantage |
$0.49
|
| Rate for Payer: UHCCP Medicaid |
$0.34
|
| Rate for Payer: VA VA |
$0.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.46
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 60687066101
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: BCBS Trust/PPO |
$160.84
|
| Rate for Payer: BCN Commercial |
$160.84
|
| Rate for Payer: Cash Price |
$155.80
|
| 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: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Nomi Health Commercial |
$159.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.38
|
| Rate for Payer: UHC Core |
$162.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$242.05
|
|
|
Service Code
|
NDC 00093970201
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna Medicare |
$62.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.64
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$60.51
|
| Rate for Payer: BCBS Trust/PPO |
$198.99
|
| Rate for Payer: BCN Commercial |
$198.99
|
| Rate for Payer: BCN Medicare Advantage |
$60.51
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.51
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Mclaren Medicaid |
$42.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.54
|
| Rate for Payer: Meridian Medicaid |
$44.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Nomi Health Commercial |
$198.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: PACE Senior Care Partners |
$57.49
|
| Rate for Payer: PACE SWMI |
$60.51
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: PHP Medicare Advantage |
$60.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.58
|
| Rate for Payer: Priority Health Medicare |
$61.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$60.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.00
|
| Rate for Payer: UHC Core |
$202.11
|
| Rate for Payer: UHC Exchange |
$60.51
|
| Rate for Payer: UHC Medicaid |
$42.67
|
| Rate for Payer: UHC Medicare Advantage |
$60.51
|
| Rate for Payer: UHCCP Medicaid |
$42.67
|
| Rate for Payer: VA VA |
$60.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
NDC 00093970201
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.47 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: BCBS Trust/PPO |
$199.91
|
| Rate for Payer: BCN Commercial |
$199.91
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Nomi Health Commercial |
$198.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.00
|
| Rate for Payer: UHC Core |
$202.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
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 |
$63.39 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$93.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.36
|
| Rate for Payer: BCBS Complete |
$66.55
|
| Rate for Payer: BCBS MAPPO |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$295.59
|
| Rate for Payer: BCN Commercial |
$295.59
|
| Rate for Payer: BCN Medicare Advantage |
$89.89
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Mclaren Medicaid |
$63.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.38
|
| Rate for Payer: Meridian Medicaid |
$66.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PACE Senior Care Partners |
$85.39
|
| Rate for Payer: PACE SWMI |
$89.89
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: PHP Medicare Advantage |
$89.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.81
|
| Rate for Payer: Priority Health Medicare |
$90.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.25
|
| Rate for Payer: Railroad Medicare Medicare |
$89.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.40
|
| Rate for Payer: UHC Core |
$300.22
|
| Rate for Payer: UHC Exchange |
$89.89
|
| Rate for Payer: UHC Medicaid |
$63.39
|
| Rate for Payer: UHC Medicare Advantage |
$89.89
|
| Rate for Payer: UHCCP Medicaid |
$63.39
|
| Rate for Payer: VA VA |
$89.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 00904750161
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$110.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.92
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$106.34
|
| Rate for Payer: BCBS Trust/PPO |
$349.68
|
| Rate for Payer: BCN Commercial |
$349.68
|
| Rate for Payer: BCN Medicare Advantage |
$106.34
|
| 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: Health Alliance Plan Medicare Advantage |
$106.34
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Mclaren Medicaid |
$74.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.65
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PACE Senior Care Partners |
$101.02
|
| Rate for Payer: PACE SWMI |
$106.34
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: PHP Medicare Advantage |
$106.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.05
|
| Rate for Payer: Priority Health Medicare |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.04
|
| Rate for Payer: Railroad Medicare Medicare |
$106.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.31
|
| Rate for Payer: UHC Core |
$355.17
|
| Rate for Payer: UHC Exchange |
$106.34
|
| Rate for Payer: UHC Medicaid |
$74.99
|
| Rate for Payer: UHC Medicare Advantage |
$106.34
|
| Rate for Payer: UHCCP Medicaid |
$74.99
|
| Rate for Payer: VA VA |
$106.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
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 |
$34.33 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$50.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.86
|
| Rate for Payer: BCBS Complete |
$36.05
|
| Rate for Payer: BCBS MAPPO |
$48.69
|
| Rate for Payer: BCBS Trust/PPO |
$160.10
|
| Rate for Payer: BCN Commercial |
$160.10
|
| Rate for Payer: BCN Medicare Advantage |
$48.69
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.69
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Mclaren Medicaid |
$34.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.12
|
| Rate for Payer: Meridian Medicaid |
$36.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Nomi Health Commercial |
$159.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PACE Senior Care Partners |
$46.25
|
| Rate for Payer: PACE SWMI |
$48.69
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: PHP Medicare Advantage |
$48.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.43
|
| Rate for Payer: Priority Health Medicare |
$49.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.55
|
| Rate for Payer: Railroad Medicare Medicare |
$48.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.38
|
| Rate for Payer: UHC Core |
$162.62
|
| Rate for Payer: UHC Exchange |
$48.69
|
| Rate for Payer: UHC Medicaid |
$34.33
|
| Rate for Payer: UHC Medicare Advantage |
$48.69
|
| Rate for Payer: UHCCP Medicaid |
$34.33
|
| Rate for Payer: VA VA |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: BCBS Trust/PPO |
$296.95
|
| Rate for Payer: BCN Commercial |
$296.95
|
| Rate for Payer: Cash Price |
$287.64
|
| 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: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.40
|
| Rate for Payer: UHC Core |
$300.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
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 |
$139.51 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$165.55
|
| Rate for Payer: BCN Commercial |
$165.55
|
| 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 |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.51
|
| 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 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 |
$35.34 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$52.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.64
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: BCBS MAPPO |
$50.11
|
| Rate for Payer: BCBS Trust/PPO |
$164.79
|
| Rate for Payer: BCN Commercial |
$164.79
|
| Rate for Payer: BCN Medicare Advantage |
$50.11
|
| 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: Health Alliance Plan Medicare Advantage |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Mclaren Medicaid |
$35.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.62
|
| Rate for Payer: Meridian Medicaid |
$37.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.34
|
| Rate for Payer: PACE Senior Care Partners |
$47.61
|
| Rate for Payer: PACE SWMI |
$50.11
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: PHP Medicare Advantage |
$50.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Medicare |
$50.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.51
|
| Rate for Payer: Railroad Medicare Medicare |
$50.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: UHC Exchange |
$50.11
|
| Rate for Payer: UHC Medicaid |
$35.34
|
| Rate for Payer: UHC Medicare Advantage |
$50.11
|
| Rate for Payer: UHCCP Medicaid |
$35.34
|
| Rate for Payer: VA VA |
$50.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$308.64
|
|
|
Service Code
|
NDC 00378008801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.41 |
| Max. Negotiated Rate |
$277.78 |
| Rate for Payer: Aetna Commercial |
$262.34
|
| Rate for Payer: Aetna Medicare |
$80.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.45
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: BCBS MAPPO |
$77.16
|
| Rate for Payer: BCBS Trust/PPO |
$253.73
|
| Rate for Payer: BCN Commercial |
$253.73
|
| Rate for Payer: BCN Medicare Advantage |
$77.16
|
| 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: Health Alliance Plan Medicare Advantage |
$77.16
|
| Rate for Payer: Healthscope Commercial |
$277.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.48
|
| Rate for Payer: Mclaren Medicaid |
$54.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.02
|
| Rate for Payer: Meridian Medicaid |
$57.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.34
|
| Rate for Payer: Nomi Health Commercial |
$253.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.48
|
| Rate for Payer: PACE Senior Care Partners |
$73.30
|
| Rate for Payer: PACE SWMI |
$77.16
|
| Rate for Payer: PHP Commercial |
$262.34
|
| Rate for Payer: PHP Medicare Advantage |
$77.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.52
|
| Rate for Payer: Priority Health Medicare |
$77.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.81
|
| Rate for Payer: Railroad Medicare Medicare |
$77.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.60
|
| Rate for Payer: UHC Core |
$257.71
|
| Rate for Payer: UHC Exchange |
$77.16
|
| Rate for Payer: UHC Medicaid |
$54.41
|
| Rate for Payer: UHC Medicare Advantage |
$77.16
|
| Rate for Payer: UHCCP Medicaid |
$54.41
|
| Rate for Payer: VA VA |
$77.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.48
|
|
