|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: BCBS Trust/PPO |
$262.84
|
| Rate for Payer: BCN Commercial |
$262.84
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.45
|
| Rate for Payer: BCBS Complete |
$58.91
|
| Rate for Payer: BCBS MAPPO |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$261.63
|
| Rate for Payer: BCN Commercial |
$261.63
|
| Rate for Payer: BCN Medicare Advantage |
$79.56
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.56
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Mclaren Medicaid |
$56.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.54
|
| Rate for Payer: Meridian Medicaid |
$58.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PACE Senior Care Partners |
$75.58
|
| Rate for Payer: PACE SWMI |
$79.56
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: PHP Medicare Advantage |
$79.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| Rate for Payer: Railroad Medicare Medicare |
$79.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: UHC Exchange |
$79.56
|
| Rate for Payer: UHC Medicaid |
$56.11
|
| Rate for Payer: UHC Medicare Advantage |
$79.56
|
| Rate for Payer: UHCCP Medicaid |
$56.11
|
| Rate for Payer: VA VA |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$0.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Medicaid |
$0.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicaid |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.56
|
| Rate for Payer: VA VA |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$331.55
|
|
|
Service Code
|
NDC 62756046188
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.45 |
| Max. Negotiated Rate |
$298.39 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna Medicare |
$86.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.61
|
| Rate for Payer: BCBS Complete |
$61.37
|
| Rate for Payer: BCBS MAPPO |
$82.89
|
| Rate for Payer: BCBS Trust/PPO |
$272.57
|
| Rate for Payer: BCN Commercial |
$272.57
|
| Rate for Payer: BCN Medicare Advantage |
$82.89
|
| 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: Health Alliance Plan Medicare Advantage |
$82.89
|
| Rate for Payer: Healthscope Commercial |
$298.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Mclaren Medicaid |
$58.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.03
|
| Rate for Payer: Meridian Medicaid |
$61.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Nomi Health Commercial |
$271.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.66
|
| Rate for Payer: PACE Senior Care Partners |
$78.74
|
| Rate for Payer: PACE SWMI |
$82.89
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: PHP Medicare Advantage |
$82.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$288.45
|
| Rate for Payer: Priority Health Medicare |
$83.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.76
|
| Rate for Payer: Railroad Medicare Medicare |
$82.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.76
|
| Rate for Payer: UHC Core |
$276.84
|
| Rate for Payer: UHC Exchange |
$82.89
|
| Rate for Payer: UHC Medicaid |
$58.45
|
| Rate for Payer: UHC Medicare Advantage |
$82.89
|
| Rate for Payer: UHCCP Medicaid |
$58.45
|
| Rate for Payer: VA VA |
$82.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$327.84
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna Medicare |
$85.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.45
|
| Rate for Payer: BCBS Complete |
$60.68
|
| Rate for Payer: BCBS MAPPO |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$269.52
|
| Rate for Payer: BCN Commercial |
$269.52
|
| Rate for Payer: BCN Medicare Advantage |
$81.96
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.96
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Mclaren Medicaid |
$57.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.06
|
| Rate for Payer: Meridian Medicaid |
$60.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: PACE Senior Care Partners |
$77.86
|
| Rate for Payer: PACE SWMI |
$81.96
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Medicare |
$82.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.18
|
| Rate for Payer: Railroad Medicare Medicare |
$81.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.50
|
| Rate for Payer: UHC Core |
$273.75
|
| Rate for Payer: UHC Exchange |
$81.96
|
| Rate for Payer: UHC Medicaid |
$57.80
|
| Rate for Payer: UHC Medicare Advantage |
$81.96
|
| Rate for Payer: UHCCP Medicaid |
$57.80
|
| Rate for Payer: VA VA |
$81.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.02
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.46
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: Meridian Medicaid |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.79
|
| Rate for Payer: Nomi Health Commercial |
$2.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.46
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.79
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.85
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.74
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.46
|
|
|
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
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.18 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$270.76
|
| Rate for Payer: BCN Commercial |
$270.76
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.50
|
| Rate for Payer: UHC Core |
$273.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.71
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.79
|
| Rate for Payer: Nomi Health Commercial |
$2.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.46
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 62756046188
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.76 |
| Max. Negotiated Rate |
$298.39 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: BCBS Trust/PPO |
$273.83
|
| Rate for Payer: BCN Commercial |
$273.83
|
| 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 |
$298.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Nomi Health Commercial |
$271.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.66
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$288.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.76
|
| 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
|
$3.19
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.63
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.33
|
| Rate for Payer: BCN Commercial |
$23.33
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.83
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.42
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PACE Senior Care Partners |
$6.71
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicaid |
$4.98
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$12,886.24
|
|
|
Service Code
|
APR-DRG 1964
|
| Min. Negotiated Rate |
$12,272.60 |
| Max. Negotiated Rate |
$12,886.24 |
| Rate for Payer: BCBS Complete |
$12,886.24
|
| Rate for Payer: Mclaren Medicaid |
$12,272.60
|
| Rate for Payer: Meridian Medicaid |
$12,886.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,272.60
|
| Rate for Payer: UHC Medicaid |
$12,272.60
|
| Rate for Payer: UHCCP Medicaid |
$12,272.60
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$1,816.78
|
|
|
Service Code
|
APR-DRG 1961
|
| Min. Negotiated Rate |
$1,730.26 |
| Max. Negotiated Rate |
$1,816.78 |
| Rate for Payer: BCBS Complete |
$1,816.78
|
| Rate for Payer: Mclaren Medicaid |
$1,730.26
|
| Rate for Payer: Meridian Medicaid |
$1,816.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,730.26
|
| Rate for Payer: UHC Medicaid |
$1,730.26
|
| Rate for Payer: UHCCP Medicaid |
$1,730.26
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$7,710.92
|
|
|
Service Code
|
APR-DRG 1963
|
| Min. Negotiated Rate |
$7,343.73 |
| Max. Negotiated Rate |
$7,710.92 |
| Rate for Payer: BCBS Complete |
$7,710.92
|
| Rate for Payer: Mclaren Medicaid |
$7,343.73
|
| Rate for Payer: Meridian Medicaid |
$7,710.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,343.73
|
| Rate for Payer: UHC Medicaid |
$7,343.73
|
| Rate for Payer: UHCCP Medicaid |
$7,343.73
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$3,514.71
|
|
|
Service Code
|
APR-DRG 1962
|
| Min. Negotiated Rate |
$3,347.35 |
| Max. Negotiated Rate |
$3,514.71 |
| Rate for Payer: BCBS Complete |
$3,514.71
|
| Rate for Payer: Mclaren Medicaid |
$3,347.35
|
| Rate for Payer: Meridian Medicaid |
$3,514.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,347.35
|
| Rate for Payer: UHC Medicaid |
$3,347.35
|
| Rate for Payer: UHCCP Medicaid |
$3,347.35
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$5,480.30
|
|
|
Service Code
|
APR-DRG 2013
|
| Min. Negotiated Rate |
$5,219.34 |
| Max. Negotiated Rate |
$5,480.30 |
| Rate for Payer: BCBS Complete |
$5,480.30
|
| Rate for Payer: Mclaren Medicaid |
$5,219.34
|
| Rate for Payer: Meridian Medicaid |
$5,480.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,219.34
|
| Rate for Payer: UHC Medicaid |
$5,219.34
|
| Rate for Payer: UHCCP Medicaid |
$5,219.34
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$3,854.41
|
|
|
Service Code
|
APR-DRG 2012
|
| Min. Negotiated Rate |
$3,670.86 |
| Max. Negotiated Rate |
$3,854.41 |
| Rate for Payer: BCBS Complete |
$3,854.41
|
| Rate for Payer: Mclaren Medicaid |
$3,670.86
|
| Rate for Payer: Meridian Medicaid |
$3,854.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,670.86
|
| Rate for Payer: UHC Medicaid |
$3,670.86
|
| Rate for Payer: UHCCP Medicaid |
$3,670.86
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$2,846.90
|
|
|
Service Code
|
APR-DRG 2011
|
| Min. Negotiated Rate |
$2,711.33 |
| Max. Negotiated Rate |
$2,846.90 |
| Rate for Payer: BCBS Complete |
$2,846.90
|
| Rate for Payer: Mclaren Medicaid |
$2,711.33
|
| Rate for Payer: Meridian Medicaid |
$2,846.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,711.33
|
| Rate for Payer: UHC Medicaid |
$2,711.33
|
| Rate for Payer: UHCCP Medicaid |
$2,711.33
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$9,484.58
|
|
|
Service Code
|
APR-DRG 2014
|
| Min. Negotiated Rate |
$9,032.93 |
| Max. Negotiated Rate |
$9,484.58 |
| Rate for Payer: BCBS Complete |
$9,484.58
|
| Rate for Payer: Mclaren Medicaid |
$9,032.93
|
| Rate for Payer: Meridian Medicaid |
$9,484.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,032.93
|
| Rate for Payer: UHC Medicaid |
$9,032.93
|
| Rate for Payer: UHCCP Medicaid |
$9,032.93
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$11,387.07
|
|
|
Service Code
|
APR-DRG 1914
|
| Min. Negotiated Rate |
$10,844.82 |
| Max. Negotiated Rate |
$11,387.07 |
| Rate for Payer: BCBS Complete |
$11,387.07
|
| Rate for Payer: Mclaren Medicaid |
$10,844.82
|
| Rate for Payer: Meridian Medicaid |
$11,387.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,844.82
|
| Rate for Payer: UHC Medicaid |
$10,844.82
|
| Rate for Payer: UHCCP Medicaid |
$10,844.82
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$6,067.14
|
|
|
Service Code
|
APR-DRG 1912
|
| Min. Negotiated Rate |
$5,778.23 |
| Max. Negotiated Rate |
$6,067.14 |
| Rate for Payer: BCBS Complete |
$6,067.14
|
| Rate for Payer: Mclaren Medicaid |
$5,778.23
|
| Rate for Payer: Meridian Medicaid |
$6,067.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,778.23
|
| Rate for Payer: UHC Medicaid |
$5,778.23
|
| Rate for Payer: UHCCP Medicaid |
$5,778.23
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$4,864.02
|
|
|
Service Code
|
APR-DRG 1911
|
| Min. Negotiated Rate |
$4,632.40 |
| Max. Negotiated Rate |
$4,864.02 |
| Rate for Payer: BCBS Complete |
$4,864.02
|
| Rate for Payer: Mclaren Medicaid |
$4,632.40
|
| Rate for Payer: Meridian Medicaid |
$4,864.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,632.40
|
| Rate for Payer: UHC Medicaid |
$4,632.40
|
| Rate for Payer: UHCCP Medicaid |
$4,632.40
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$8,331.93
|
|
|
Service Code
|
APR-DRG 1913
|
| Min. Negotiated Rate |
$7,935.18 |
| Max. Negotiated Rate |
$8,331.93 |
| Rate for Payer: BCBS Complete |
$8,331.93
|
| Rate for Payer: Mclaren Medicaid |
$7,935.18
|
| Rate for Payer: Meridian Medicaid |
$8,331.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,935.18
|
| Rate for Payer: UHC Medicaid |
$7,935.18
|
| Rate for Payer: UHCCP Medicaid |
$7,935.18
|
|
