|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$7.99
|
| Rate for Payer: BCN Commercial |
$7.57
|
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.32
|
| Rate for Payer: Nomi Health Commercial |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health HMO/PPO |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.62
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.99
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$5.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.39
|
| Rate for Payer: BCN Commercial |
$17.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.59
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.59
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.31
|
| Rate for Payer: PACE SWMI |
$5.59
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.54
|
| Rate for Payer: Priority Health HMO/PPO |
$19.46
|
| Rate for Payer: Priority Health Medicare |
$5.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.69
|
| Rate for Payer: UHC Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.59
|
| Rate for Payer: UHC Exchange |
$5.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.59
|
| Rate for Payer: VA VA |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.78 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Trust/PPO |
$159.22
|
| Rate for Payer: BCN Commercial |
$150.73
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.95
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: BCBS MAPPO |
$48.76
|
| Rate for Payer: BCBS Trust/PPO |
$160.35
|
| Rate for Payer: BCN Commercial |
$151.65
|
| Rate for Payer: BCN Medicare Advantage |
$48.76
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.76
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Nomi Health Commercial |
$159.94
|
| Rate for Payer: PACE Senior Care Partners |
$46.32
|
| Rate for Payer: PACE SWMI |
$48.76
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: PHP Medicare Advantage |
$48.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health HMO/PPO |
$169.69
|
| Rate for Payer: Priority Health Medicare |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.68
|
| Rate for Payer: Railroad Medicare Medicare |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.64
|
| Rate for Payer: UHC Core |
$162.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.76
|
| Rate for Payer: UHC Exchange |
$48.76
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
| Rate for Payer: VA VA |
$48.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00378007801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00378007801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$179.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.71
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 60687066101
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.02
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS MAPPO |
$52.01
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$161.76
|
| Rate for Payer: BCN Medicare Advantage |
$52.01
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.01
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: PACE Senior Care Partners |
$49.41
|
| Rate for Payer: PACE SWMI |
$52.01
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: PHP Medicare Advantage |
$52.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.39
|
| Rate for Payer: Railroad Medicare Medicare |
$52.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.01
|
| Rate for Payer: UHC Exchange |
$52.01
|
| Rate for Payer: UHC Medicare Advantage |
$52.01
|
| Rate for Payer: VA VA |
$52.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 60687066111
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.71 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: BCBS Trust/PPO |
$293.50
|
| Rate for Payer: BCN Commercial |
$277.86
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.71
|
| Rate for Payer: Priority Health HMO/PPO |
$312.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.40
|
| Rate for Payer: UHC Core |
$300.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$268.56
|
| Rate for Payer: BCN Commercial |
$254.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 60687066111
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.39 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$93.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.36
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: BCBS MAPPO |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$295.59
|
| Rate for Payer: BCN Commercial |
$279.55
|
| Rate for Payer: BCN Medicare Advantage |
$89.89
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: PACE Senior Care Partners |
$85.39
|
| Rate for Payer: PACE SWMI |
$89.89
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: PHP Medicare Advantage |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.71
|
| Rate for Payer: Priority Health HMO/PPO |
$312.81
|
| Rate for Payer: Priority Health Medicare |
$90.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.90
|
| Rate for Payer: Railroad Medicare Medicare |
$89.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.40
|
| Rate for Payer: UHC Core |
$300.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.89
|
| Rate for Payer: UHC Exchange |
$89.89
|
| Rate for Payer: UHC Medicare Advantage |
$89.89
|
| Rate for Payer: VA VA |
$89.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$85.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.81
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$255.80
|
| Rate for Payer: BCN Medicare Advantage |
$82.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.25
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: PACE Senior Care Partners |
$78.14
|
| Rate for Payer: PACE SWMI |
$82.25
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: PHP Medicare Advantage |
$82.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.25
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: VA VA |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 60687066101
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.83
|
| Rate for Payer: BCN Commercial |
$160.78
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO |
$181.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.08
|
| Rate for Payer: UHC Core |
$173.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.61 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna Medicare |
$52.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.64
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS MAPPO |
$50.11
|
| Rate for Payer: BCBS Trust/PPO |
$164.79
|
| Rate for Payer: BCN Commercial |
$155.85
|
| Rate for Payer: BCN Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: PACE Senior Care Partners |
$47.61
|
| Rate for Payer: PACE SWMI |
$50.11
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: PHP Medicare Advantage |
$50.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Medicare |
$50.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.30
|
| Rate for Payer: Railroad Medicare Medicare |
$50.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.11
|
| Rate for Payer: UHC Exchange |
$50.11
|
| Rate for Payer: UHC Medicare Advantage |
$50.11
|
| Rate for Payer: VA VA |
$50.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$180.41 |
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: BCBS Trust/PPO |
$163.63
|
| Rate for Payer: BCN Commercial |
$154.91
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO |
$174.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.40
|
| Rate for Payer: UHC Core |
$167.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
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
|
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
|
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
|
|
|
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 |
$298.39 |
| 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 |
$298.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.82
|
| Rate for Payer: Nomi Health Commercial |
$271.87
|
| Rate for Payer: 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
|
$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
|
OP
|
$331.55
|
|
|
Service Code
|
NDC 62756046188
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.74 |
| Max. Negotiated Rate |
$298.39 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna Medicare |
$86.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.61
|
| Rate for Payer: BCBS Complete |
$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 |
$298.39
|
| 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
|
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
|
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
|
$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
|
|
