|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00904730561
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 68084084311
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.53
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 68462016201
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$622.75
|
|
|
Service Code
|
NDC 68462016205
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$560.48 |
| Rate for Payer: Aetna American Axle |
$404.79
|
| Rate for Payer: Aetna Commercial |
$529.34
|
| Rate for Payer: Aetna Medicare |
$311.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.79
|
| Rate for Payer: BCBS Complete |
$249.10
|
| Rate for Payer: Cash Price |
$498.20
|
| Rate for Payer: Cofinity Advantage |
$435.93
|
| Rate for Payer: Cofinity Commercial |
$535.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.20
|
| Rate for Payer: Healthscope Commercial |
$560.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$498.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$467.06
|
| Rate for Payer: PHP Commercial |
$529.34
|
| Rate for Payer: Priority Health SBD |
$392.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.79
|
| Rate for Payer: UHC Core |
$324.45
|
| Rate for Payer: UHC Exchange |
$244.74
|
| Rate for Payer: UMR Bronson Commercial |
$230.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.06
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 00904730561
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00378363101
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 68084084301
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Advantage |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 68382009301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 68462016301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
NDC 51079093001
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Advantage |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.39
|
| Rate for Payer: UHC Core |
$1.11
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UMR Bronson Commercial |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.67
|
| Rate for Payer: UHC Core |
$96.72
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 68382009301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.72
|
| Rate for Payer: UHC Core |
$31.83
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UMR Bronson Commercial |
$22.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 51079093020
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Advantage |
$149.69
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.39
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904730661
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904630161
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 68462016301
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 51079093001
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cofinity Advantage |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
|
|
CARVEDILOL 6.25 MG TABLET
|
Facility
|
OP
|
$213.85
|
|
|
Service Code
|
NDC 51079093020
|
| Hospital Charge Code |
15747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Advantage |
$149.69
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.39
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.00
|
| Rate for Payer: UHC Core |
$111.42
|
| Rate for Payer: UHC Exchange |
$84.04
|
| Rate for Payer: UMR Bronson Commercial |
$79.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,005.03
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$904.53 |
| Rate for Payer: Aetna American Axle |
$653.27
|
| Rate for Payer: Aetna Commercial |
$854.28
|
| Rate for Payer: Aetna Medicare |
$502.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.27
|
| Rate for Payer: BCBS Complete |
$402.01
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cofinity Advantage |
$703.52
|
| Rate for Payer: Cofinity Commercial |
$864.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.02
|
| Rate for Payer: Healthscope Commercial |
$904.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$804.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.77
|
| Rate for Payer: PHP Commercial |
$854.28
|
| Rate for Payer: Priority Health SBD |
$633.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.30
|
| Rate for Payer: UHC Core |
$6.30
|
| Rate for Payer: UHC Exchange |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$371.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.77
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,005.03
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.21 |
| Max. Negotiated Rate |
$904.53 |
| Rate for Payer: Aetna American Axle |
$653.27
|
| Rate for Payer: Aetna Commercial |
$854.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.27
|
| Rate for Payer: Cash Price |
$804.02
|
| Rate for Payer: Cofinity Advantage |
$703.52
|
| Rate for Payer: Cofinity Commercial |
$864.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.02
|
| Rate for Payer: Healthscope Commercial |
$904.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$703.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.77
|
| Rate for Payer: PHP Commercial |
$854.28
|
| Rate for Payer: Priority Health SBD |
$633.17
|
| Rate for Payer: UMR Bronson Commercial |
$442.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.77
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$522.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.30
|
| Rate for Payer: UHC Core |
$6.30
|
| Rate for Payer: UHC Exchange |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$386.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
29568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$459.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
CASTOR OIL
|
Facility
|
OP
|
$8.30
|
|
|
Service Code
|
NDC 09629513775
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna American Axle |
$5.39
|
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Aetna Medicare |
$4.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.39
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cofinity Advantage |
$5.81
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$7.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.22
|
| Rate for Payer: PHP Commercial |
$7.05
|
| Rate for Payer: Priority Health SBD |
$5.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.39
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Exchange |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.22
|
|
|
CASTOR OIL
|
Facility
|
IP
|
$16.43
|
|
|
Service Code
|
NDC 00395051592
|
| Hospital Charge Code |
15209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cofinity Advantage |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
|
