|
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
|
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
|
$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
|
|
|
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 |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.83
|
| Rate for Payer: BCBS Complete |
$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 |
$25.43
|
| 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 |
$25.43 |
| 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 |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: 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
|
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
|
$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
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.98 |
| 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 |
$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 |
$162.85
|
| 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 |
$162.85 |
| 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 |
$162.85
|
| 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: 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 |
$143.59 |
| 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 |
$143.59
|
| 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
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$162.85 |
| 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 |
$162.85
|
| 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: 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
|
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 |
$55.23
|
| Rate for Payer: BCBS Trust/PPO |
$181.60
|
| Rate for Payer: BCN Commercial |
$171.75
|
| 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: 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 |
$55.23
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: PHP Medicare Advantage |
$55.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.59
|
| 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 |
$55.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.23
|
| Rate for Payer: UHC Exchange |
$55.23
|
| Rate for Payer: UHC Medicare Advantage |
$55.23
|
| Rate for Payer: VA VA |
$55.23
|
| 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 |
$162.85 |
| 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 |
$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 |
$162.85
|
| 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 |
$271.57 |
| 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 |
$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 |
$271.57
|
| 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
|
|
|
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 |
$196.14 |
| Max. Negotiated Rate |
$271.57 |
| Rate for Payer: Aetna Commercial |
$256.49
|
| Rate for Payer: BCBS Trust/PPO |
$246.32
|
| Rate for Payer: BCN Commercial |
$233.19
|
| 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: PHP Commercial |
$256.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.14
|
| Rate for Payer: Priority Health HMO/PPO |
$262.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.17
|
| 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 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$13.88
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.33
|
| Rate for Payer: BCBS Trust/PPO |
$15.84
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.73
|
| Rate for Payer: BCN Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| 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 |
$10.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.50
|
| Rate for Payer: Nomi Health Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$15.92
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health HMO/PPO |
$12.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.21
|
| Rate for Payer: UHC Core |
$11.59
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$13.88
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
1445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna Medicare |
$3.61
|
| Rate for Payer: Aetna Medicare |
$3.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.34
|
| 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 |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: BCBS Complete |
$7.76
|
| Rate for Payer: BCBS MAPPO |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$3.47
|
| Rate for Payer: BCBS MAPPO |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$10.85
|
| Rate for Payer: BCN Commercial |
$15.09
|
| Rate for Payer: BCN Commercial |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$3.47
|
| Rate for Payer: BCN Medicare Advantage |
$3.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.85
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$15.53
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.47
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$17.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.64
|
| 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 |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.58
|
| 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 |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$15.92
|
| Rate for Payer: Nomi Health Commercial |
$11.38
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: PACE Senior Care Partners |
$4.61
|
| Rate for Payer: PACE Senior Care Partners |
$3.30
|
| Rate for Payer: PACE Senior Care Partners |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.49
|
| Rate for Payer: PACE SWMI |
$3.47
|
| Rate for Payer: PACE SWMI |
$4.85
|
| Rate for Payer: PHP Commercial |
$16.50
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$4.85
|
| Rate for Payer: PHP Medicare Advantage |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO |
$12.08
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Medicare |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$4.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.21
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Core |
$11.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.49
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicare Advantage |
$3.47
|
| Rate for Payer: UHC Medicare Advantage |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$4.85
|
| Rate for Payer: VA VA |
$3.49
|
| Rate for Payer: VA VA |
$4.85
|
| Rate for Payer: VA VA |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
| 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 |
$9.07 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCN Commercial |
$10.78
|
| 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: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| 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 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 |
$3.31 |
| 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 |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$10.85
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| 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 Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| 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 Dual Complete DSNP |
$3.49
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$3.49
|
| Rate for Payer: VA VA |
$3.49
|
| 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 |
$519.19 |
| Max. Negotiated Rate |
$718.88 |
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: BCBS Trust/PPO |
$652.02
|
| Rate for Payer: BCN Commercial |
$617.27
|
| 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: PHP Commercial |
$678.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.19
|
| Rate for Payer: Priority Health HMO/PPO |
$694.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$535.16
|
| 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 |
$189.70 |
| 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 |
$319.50
|
| Rate for Payer: BCBS MAPPO |
$199.69
|
| Rate for Payer: BCBS Trust/PPO |
$656.65
|
| Rate for Payer: BCN Commercial |
$621.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.94
|
| Rate for Payer: Nomi Health Commercial |
$654.98
|
| 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 Cigna Priority Health |
$519.19
|
| Rate for Payer: Priority Health HMO/PPO |
$694.91
|
| Rate for Payer: Priority Health Medicare |
$201.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$535.16
|
| 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 Dual Complete DSNP |
$199.69
|
| Rate for Payer: UHC Exchange |
$199.69
|
| Rate for Payer: UHC Medicare Advantage |
$199.69
|
| 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 |
$1.85 |
| 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 |
$3.12
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Commercial |
$6.07
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| 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 Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.23
|
| 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 Dual Complete DSNP |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| 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 |
$5.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.38
|
| Rate for Payer: BCN Commercial |
$6.04
|
| 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: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.08
|
| Rate for Payer: Priority Health HMO/PPO |
$6.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.23
|
| 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
|
|
