|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.22 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: BCBS Trust/PPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$210.70
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health HMO/PPO |
$237.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.93
|
| Rate for Payer: UHC Core |
$227.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
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 |
$215.51 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: BCBS Trust/PPO |
$270.64
|
| Rate for Payer: BCN Commercial |
$256.22
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Nomi Health Commercial |
$271.87
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.51
|
| Rate for Payer: Priority Health HMO/PPO |
$288.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.14
|
| 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
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| 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 |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.55
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.79
|
| Rate for Payer: Nomi Health Commercial |
$2.69
|
| 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 Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.85
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.20
|
| 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 Dual Complete DSNP |
$0.82
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| 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
|
$331.55
|
|
|
Service Code
|
NDC 62756046188
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.74 |
| Max. Negotiated Rate |
$298.40 |
| 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 |
$132.62
|
| Rate for Payer: BCBS MAPPO |
$82.89
|
| Rate for Payer: BCBS Trust/PPO |
$272.57
|
| Rate for Payer: BCN Commercial |
$257.78
|
| 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 |
$298.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Nomi Health Commercial |
$271.87
|
| 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 Cigna Priority Health |
$215.51
|
| Rate for Payer: Priority Health HMO/PPO |
$288.45
|
| Rate for Payer: Priority Health Medicare |
$83.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.14
|
| 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 Dual Complete DSNP |
$82.89
|
| Rate for Payer: UHC Exchange |
$82.89
|
| Rate for Payer: UHC Medicare Advantage |
$82.89
|
| 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
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.53
|
| 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: PHP Commercial |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.20
|
| 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
|
OP
|
$327.84
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.86 |
| 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 |
$131.14
|
| Rate for Payer: BCBS MAPPO |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$269.52
|
| Rate for Payer: BCN Commercial |
$254.90
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Nomi Health Commercial |
$268.83
|
| 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 Cigna Priority Health |
$213.10
|
| Rate for Payer: Priority Health HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Medicare |
$82.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.65
|
| 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 Dual Complete DSNP |
$81.96
|
| Rate for Payer: UHC Exchange |
$81.96
|
| Rate for Payer: UHC Medicare Advantage |
$81.96
|
| 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
|
$308.64
|
|
|
Service Code
|
NDC 00378008801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.30 |
| 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 |
$123.46
|
| Rate for Payer: BCBS MAPPO |
$77.16
|
| Rate for Payer: BCBS Trust/PPO |
$253.73
|
| Rate for Payer: BCN Commercial |
$239.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.34
|
| Rate for Payer: Nomi Health Commercial |
$253.08
|
| 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 Cigna Priority Health |
$200.62
|
| Rate for Payer: Priority Health HMO/PPO |
$268.52
|
| Rate for Payer: Priority Health Medicare |
$77.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.79
|
| 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 Dual Complete DSNP |
$77.16
|
| Rate for Payer: UHC Exchange |
$77.16
|
| Rate for Payer: UHC Medicare Advantage |
$77.16
|
| 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
|
$308.64
|
|
|
Service Code
|
NDC 00378008801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$277.78 |
| Rate for Payer: Aetna Commercial |
$262.34
|
| Rate for Payer: BCBS Trust/PPO |
$251.94
|
| Rate for Payer: BCN Commercial |
$238.52
|
| Rate for Payer: Cash Price |
$246.91
|
| Rate for Payer: Cofinity Commercial |
$265.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.91
|
| Rate for Payer: Healthscope Commercial |
$277.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.34
|
| Rate for Payer: Nomi Health Commercial |
$253.08
|
| Rate for Payer: PHP Commercial |
$262.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.62
|
| Rate for Payer: Priority Health HMO/PPO |
$268.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.60
|
| Rate for Payer: UHC Core |
$257.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.48
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 68084028101
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.10 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$267.62
|
| Rate for Payer: BCN Commercial |
$253.35
|
| 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: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.10
|
| Rate for Payer: Priority Health HMO/PPO |
$285.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.65
|
| 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
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$70.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.20
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: BCBS MAPPO |
$68.16
|
| Rate for Payer: BCBS Trust/PPO |
$224.15
|
| Rate for Payer: BCN Commercial |
$211.99
|
| Rate for Payer: BCN Medicare Advantage |
$68.16
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.16
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: PACE Senior Care Partners |
$64.75
|
| Rate for Payer: PACE SWMI |
$68.16
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health HMO/PPO |
$237.21
|
| Rate for Payer: Priority Health Medicare |
$68.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.68
|
| Rate for Payer: Railroad Medicare Medicare |
$68.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.93
|
| Rate for Payer: UHC Core |
$227.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.16
|
| Rate for Payer: UHC Exchange |
$68.16
|
| Rate for Payer: UHC Medicare Advantage |
$68.16
|
| Rate for Payer: VA VA |
$68.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
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 |
$6.71 |
| Max. Negotiated Rate |
$25.42 |
| 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 |
$11.30
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$21.96
|
| 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 |
$25.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| 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 Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| 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 Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
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 |
$18.36 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.83
|
| 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 |
$25.42
|
| 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: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| 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
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.97
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: BCBS MAPPO |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$65.69
|
| Rate for Payer: BCN Commercial |
$62.12
|
| Rate for Payer: BCN Medicare Advantage |
$19.98
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Nomi Health Commercial |
$65.52
|
| Rate for Payer: PACE Senior Care Partners |
$18.98
|
| Rate for Payer: PACE SWMI |
$19.98
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health HMO/PPO |
$69.51
|
| Rate for Payer: Priority Health Medicare |
$20.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.31
|
| Rate for Payer: UHC Core |
$66.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.98
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicare Advantage |
$19.98
|
| Rate for Payer: VA VA |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Nomi Health Commercial |
$65.52
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health HMO/PPO |
$69.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.31
|
| Rate for Payer: UHC Core |
$66.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$162.86 |
| 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 |
$72.38
|
| Rate for Payer: BCBS MAPPO |
$45.24
|
| Rate for Payer: BCBS Trust/PPO |
$148.76
|
| Rate for Payer: BCN Commercial |
$140.69
|
| 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 |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| 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 Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Medicare |
$45.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.24
|
| 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 Dual Complete DSNP |
$45.24
|
| Rate for Payer: UHC Exchange |
$45.24
|
| Rate for Payer: UHC Medicare Advantage |
$45.24
|
| 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 |
$117.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$147.71
|
| Rate for Payer: BCN Commercial |
$139.84
|
| 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 |
$162.86
|
| 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: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.24
|
| 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
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: BCBS Trust/PPO |
$147.71
|
| Rate for Payer: BCN Commercial |
$139.84
|
| 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 |
$162.86
|
| 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: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.24
|
| 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 |
$143.58 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$180.32
|
| Rate for Payer: BCN Commercial |
$170.71
|
| 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: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.00
|
| 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
|
OP
|
$220.90
|
|
|
Service Code
|
NDC 43547025410
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.46 |
| 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 |
$88.36
|
| Rate for Payer: BCBS MAPPO |
$55.22
|
| Rate for Payer: BCBS Trust/PPO |
$181.60
|
| Rate for Payer: BCN Commercial |
$171.75
|
| Rate for Payer: BCN Medicare Advantage |
$55.22
|
| 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 |
$55.22
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Nomi Health Commercial |
$181.14
|
| Rate for Payer: PACE Senior Care Partners |
$52.46
|
| Rate for Payer: PACE SWMI |
$55.22
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: PHP Medicare Advantage |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health HMO/PPO |
$192.18
|
| Rate for Payer: Priority Health Medicare |
$55.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.00
|
| Rate for Payer: Railroad Medicare Medicare |
$55.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.22
|
| Rate for Payer: UHC Exchange |
$55.22
|
| Rate for Payer: UHC Medicare Advantage |
$55.22
|
| Rate for Payer: VA VA |
$55.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$162.86 |
| 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 |
$72.38
|
| Rate for Payer: BCBS MAPPO |
$45.24
|
| Rate for Payer: BCBS Trust/PPO |
$148.76
|
| Rate for Payer: BCN Commercial |
$140.69
|
| 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 |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| 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 Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health HMO/PPO |
$157.43
|
| Rate for Payer: Priority Health Medicare |
$45.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.24
|
| 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 Dual Complete DSNP |
$45.24
|
| Rate for Payer: UHC Exchange |
$45.24
|
| Rate for Payer: UHC Medicare Advantage |
$45.24
|
| Rate for Payer: VA VA |
$45.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.65 |
| 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 |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$146.17
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| 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 Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.96
|
| 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 Dual Complete DSNP |
$47.00
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| 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
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.46
|
| Rate for Payer: BCN Commercial |
$145.29
|
| 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: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.96
|
| 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
|
|
|
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 |
$71.67 |
| Max. Negotiated Rate |
$271.58 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: Aetna Medicare |
$78.46
|
| 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 |
$120.70
|
| Rate for Payer: BCBS MAPPO |
$75.44
|
| Rate for Payer: BCBS Trust/PPO |
$248.07
|
| Rate for Payer: BCN Commercial |
$234.61
|
| 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 |
$271.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.49
|
| Rate for Payer: Nomi Health Commercial |
$247.44
|
| 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 Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health HMO/PPO |
$262.52
|
| Rate for Payer: Priority Health Medicare |
$76.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.17
|
| 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 Dual Complete DSNP |
$75.44
|
| Rate for Payer: UHC Exchange |
$75.44
|
| Rate for Payer: UHC Medicare Advantage |
$75.44
|
| Rate for Payer: VA VA |
$75.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.31
|
|
