|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$60.17
|
| Rate for Payer: BCN Commercial |
$60.17
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.89
|
| Rate for Payer: BCN Commercial |
$59.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Mclaren Medicaid |
$12.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Meridian Medicaid |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Nomi Health Commercial |
$59.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.38
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.84
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 00904730761
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.91
|
| Rate for Payer: BCBS Complete |
$44.37
|
| Rate for Payer: BCBS MAPPO |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$197.06
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: BCN Medicare Advantage |
$59.92
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.92
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$42.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.92
|
| Rate for Payer: Meridian Medicaid |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PACE Senior Care Partners |
$56.93
|
| Rate for Payer: PACE SWMI |
$59.92
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: PHP Medicare Advantage |
$59.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Medicare |
$60.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.83
|
| Rate for Payer: Railroad Medicare Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: UHC Exchange |
$59.92
|
| Rate for Payer: UHC Medicaid |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$59.92
|
| Rate for Payer: UHCCP Medicaid |
$42.26
|
| Rate for Payer: VA VA |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$162.85 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna Medicare |
$47.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.55
|
| Rate for Payer: BCBS Complete |
$33.49
|
| Rate for Payer: BCBS MAPPO |
$45.24
|
| Rate for Payer: BCBS Trust/PPO |
$148.76
|
| Rate for Payer: BCN Commercial |
$148.76
|
| Rate for Payer: BCN Medicare Advantage |
$45.24
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.24
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Mclaren Medicaid |
$31.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.50
|
| Rate for Payer: Meridian Medicaid |
$33.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PACE Senior Care Partners |
$42.98
|
| Rate for Payer: PACE SWMI |
$45.24
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Medicare |
$45.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.94
|
| Rate for Payer: Railroad Medicare Medicare |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: UHC Exchange |
$45.24
|
| Rate for Payer: UHC Medicaid |
$31.90
|
| Rate for Payer: UHC Medicare Advantage |
$45.24
|
| Rate for Payer: UHCCP Medicaid |
$31.90
|
| Rate for Payer: VA VA |
$45.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$162.85 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$149.45
|
| Rate for Payer: BCN Commercial |
$149.45
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 43547025410
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$182.44
|
| Rate for Payer: BCN Commercial |
$182.44
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 00904730561
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: BCBS Trust/PPO |
$151.39
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$162.85 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna Medicare |
$47.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.55
|
| Rate for Payer: BCBS Complete |
$33.49
|
| Rate for Payer: BCBS MAPPO |
$45.24
|
| Rate for Payer: BCBS Trust/PPO |
$148.76
|
| Rate for Payer: BCN Commercial |
$148.76
|
| Rate for Payer: BCN Medicare Advantage |
$45.24
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.24
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Mclaren Medicaid |
$31.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.50
|
| Rate for Payer: Meridian Medicaid |
$33.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PACE Senior Care Partners |
$42.98
|
| Rate for Payer: PACE SWMI |
$45.24
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Medicare |
$45.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.94
|
| Rate for Payer: Railroad Medicare Medicare |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: UHC Exchange |
$45.24
|
| Rate for Payer: UHC Medicaid |
$31.90
|
| Rate for Payer: UHC Medicare Advantage |
$45.24
|
| Rate for Payer: UHCCP Medicaid |
$31.90
|
| Rate for Payer: VA VA |
$45.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00904730561
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 43547025410
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$57.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.03
|
| Rate for Payer: BCBS Complete |
$40.89
|
| Rate for Payer: BCBS MAPPO |
$55.23
|
| Rate for Payer: BCBS Trust/PPO |
$181.60
|
| Rate for Payer: BCN Commercial |
$181.60
|
| Rate for Payer: BCN Medicare Advantage |
$55.23
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.23
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Mclaren Medicaid |
$38.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.99
|
| Rate for Payer: Meridian Medicaid |
$40.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.68
|
| Rate for Payer: PACE Senior Care Partners |
$52.46
|
| Rate for Payer: PACE SWMI |
$55.23
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: PHP Medicare Advantage |
$55.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Medicare |
$55.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.75
|
| Rate for Payer: Railroad Medicare Medicare |
$55.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: UHC Exchange |
$55.23
|
| Rate for Payer: UHC Medicaid |
$38.94
|
| Rate for Payer: UHC Medicare Advantage |
$55.23
|
| Rate for Payer: UHCCP Medicaid |
$38.94
|
| Rate for Payer: VA VA |
$55.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$162.85 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$149.45
|
| Rate for Payer: BCN Commercial |
$149.45
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.24
|
| Rate for Payer: UHC Core |
$151.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$152.62
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.33
|
| Rate for Payer: BCN Commercial |
$153.33
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.02 |
| Max. Negotiated Rate |
$271.57 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Healthscope Commercial |
$271.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: Nomi Health Commercial |
$247.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.31
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.54
|
| Rate for Payer: UHC Core |
$251.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$301.75
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
31086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$271.57 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna Medicare |
$78.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.30
|
| Rate for Payer: BCBS Complete |
$55.85
|
| Rate for Payer: BCBS MAPPO |
$75.44
|
| Rate for Payer: BCBS Trust/PPO |
$248.07
|
| Rate for Payer: BCN Commercial |
$248.07
|
| Rate for Payer: BCN Medicare Advantage |
$75.44
|
| Rate for Payer: Cash Price |
$241.40
|
| Rate for Payer: Cofinity Commercial |
$259.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.44
|
| Rate for Payer: Healthscope Commercial |
$271.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Mclaren Medicaid |
$53.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.21
|
| Rate for Payer: Meridian Medicaid |
$55.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: Nomi Health Commercial |
$247.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.31
|
| Rate for Payer: PACE Senior Care Partners |
$71.67
|
| Rate for Payer: PACE SWMI |
$75.44
|
| Rate for Payer: PHP Commercial |
$256.49
|
| Rate for Payer: PHP Medicare Advantage |
$75.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.52
|
| Rate for Payer: Priority Health Medicare |
$76.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.02
|
| Rate for Payer: Railroad Medicare Medicare |
$75.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.54
|
| Rate for Payer: UHC Core |
$251.96
|
| Rate for Payer: UHC Exchange |
$75.44
|
| Rate for Payer: UHC Medicaid |
$53.20
|
| Rate for Payer: UHC Medicare Advantage |
$75.44
|
| Rate for Payer: UHCCP Medicaid |
$53.20
|
| Rate for Payer: VA VA |
$75.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna Medicare |
$3.63
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.07
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$3.49
|
| Rate for Payer: BCBS MAPPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Medicare Advantage |
$4.85
|
| Rate for Payer: BCN Medicare Advantage |
$3.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.49
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.51
|
| Rate for Payer: Mclaren Medicaid |
$2.46
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$3.59
|
| Rate for Payer: Meridian Medicaid |
$2.58
|
| Rate for Payer: Meridian Medicaid |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Nomi Health Commercial |
$15.92
|
| Rate for Payer: Nomi Health Commercial |
$11.49
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PACE Senior Care Partners |
$3.33
|
| Rate for Payer: PACE Senior Care Partners |
$3.31
|
| Rate for Payer: PACE Senior Care Partners |
$4.61
|
| Rate for Payer: PACE SWMI |
$4.85
|
| Rate for Payer: PACE SWMI |
$3.50
|
| Rate for Payer: PACE SWMI |
$3.49
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.50
|
| Rate for Payer: PHP Medicare Advantage |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$4.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.89
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Medicare |
$3.54
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: UHC Core |
$11.70
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Exchange |
$3.50
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Medicaid |
$2.46
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicaid |
$2.47
|
| Rate for Payer: UHC Medicare Advantage |
$3.50
|
| Rate for Payer: UHC Medicare Advantage |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$4.85
|
| Rate for Payer: UHCCP Medicaid |
$2.47
|
| Rate for Payer: UHCCP Medicaid |
$2.46
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: VA VA |
$3.49
|
| Rate for Payer: VA VA |
$4.85
|
| Rate for Payer: VA VA |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$11.57
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: BCN Commercial |
$16.03
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.49
|
| Rate for Payer: Nomi Health Commercial |
$15.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.56
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: UHC Core |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.51
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$3.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.36
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: BCBS MAPPO |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: BCN Medicare Advantage |
$3.49
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Mclaren Medicaid |
$2.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.66
|
| Rate for Payer: Meridian Medicaid |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PACE Senior Care Partners |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.49
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Medicare Advantage |
$3.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Medicaid |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$3.49
|
| Rate for Payer: UHCCP Medicaid |
$2.46
|
| Rate for Payer: VA VA |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 1 GRAM SOLUTION SOLID FORM MIXTURE COMPONENT CUSTOM
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
301810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$555.93 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: BCBS Trust/PPO |
$659.69
|
| Rate for Payer: BCN Commercial |
$659.69
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: Nomi Health Commercial |
$654.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.06
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$694.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$555.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.90
|
| Rate for Payer: UHC Core |
$666.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 300 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$798.75
|
|
|
Service Code
|
NDC 66288130001
|
| Hospital Charge Code |
31087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna Medicare |
$207.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.61
|
| Rate for Payer: BCBS Complete |
$147.85
|
| Rate for Payer: BCBS MAPPO |
$199.69
|
| Rate for Payer: BCBS Trust/PPO |
$656.65
|
| Rate for Payer: BCN Commercial |
$656.65
|
| Rate for Payer: BCN Medicare Advantage |
$199.69
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cofinity Commercial |
$686.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.69
|
| Rate for Payer: Healthscope Commercial |
$718.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.06
|
| Rate for Payer: Mclaren Medicaid |
$140.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.67
|
| Rate for Payer: Meridian Medicaid |
$147.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: Nomi Health Commercial |
$654.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.06
|
| Rate for Payer: PACE Senior Care Partners |
$189.70
|
| Rate for Payer: PACE SWMI |
$199.69
|
| Rate for Payer: PHP Commercial |
$678.94
|
| Rate for Payer: PHP Medicare Advantage |
$199.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$694.91
|
| Rate for Payer: Priority Health Medicare |
$201.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$555.93
|
| Rate for Payer: Railroad Medicare Medicare |
$199.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.90
|
| Rate for Payer: UHC Core |
$666.96
|
| Rate for Payer: UHC Exchange |
$199.69
|
| Rate for Payer: UHC Medicaid |
$140.82
|
| Rate for Payer: UHC Medicare Advantage |
$199.69
|
| Rate for Payer: UHCCP Medicaid |
$140.82
|
| Rate for Payer: VA VA |
$199.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.06
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Commercial |
$6.42
|
| Rate for Payer: BCN Medicare Advantage |
$1.95
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.05
|
| Rate for Payer: Meridian Medicaid |
$1.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PACE Senior Care Partners |
$1.85
|
| Rate for Payer: PACE SWMI |
$1.95
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$1.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.87
|
| Rate for Payer: UHC Core |
$6.52
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: VA VA |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
|
CEFAZOLIN 50 MG/0.5 ML IN NS FOR DISCOGRAM
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
168899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.87
|
| Rate for Payer: UHC Core |
$6.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.86
|
|
