|
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 |
$100.88 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.04 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna American Axle |
$407.78
|
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.78
|
| Rate for Payer: Priority Health SBD |
$395.24
|
| Rate for Payer: UMR Bronson Commercial |
$276.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.52
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$627.36
|
|
|
Service Code
|
NDC 00378009401
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.12 |
| Max. Negotiated Rate |
$564.62 |
| Rate for Payer: Aetna American Axle |
$407.78
|
| Rate for Payer: Aetna Commercial |
$533.26
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.78
|
| Rate for Payer: BCBS Complete |
$250.94
|
| Rate for Payer: Cash Price |
$501.89
|
| Rate for Payer: Cofinity Commercial |
$439.15
|
| Rate for Payer: Cofinity Commercial |
$539.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.89
|
| Rate for Payer: Healthscope Commercial |
$564.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$439.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.78
|
| Rate for Payer: Priority Health SBD |
$395.24
|
| Rate for Payer: UMR Bronson Commercial |
$232.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.52
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 62756045788
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.49 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna American Axle |
$203.11
|
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.11
|
| Rate for Payer: Priority Health SBD |
$196.86
|
| Rate for Payer: UMR Bronson Commercial |
$137.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.36
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$312.48
|
|
|
Service Code
|
NDC 62756045788
|
| Hospital Charge Code |
9409
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.62 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna American Axle |
$203.11
|
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna Medicare |
$156.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.11
|
| Rate for Payer: BCBS Complete |
$124.99
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$218.74
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.11
|
| Rate for Payer: Priority Health SBD |
$196.86
|
| Rate for Payer: UMR Bronson Commercial |
$115.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.36
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$346.86
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$312.17 |
| Rate for Payer: Aetna American Axle |
$225.46
|
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna American Axle |
$151.37
|
| Rate for Payer: Aetna American Axle |
$138.57
|
| Rate for Payer: Aetna American Axle |
$105.14
|
| Rate for Payer: Aetna American Axle |
$117.73
|
| Rate for Payer: Aetna American Axle |
$142.23
|
| Rate for Payer: Aetna American Axle |
$313.90
|
| Rate for Payer: Aetna Commercial |
$410.49
|
| Rate for Payer: Aetna Commercial |
$294.83
|
| Rate for Payer: Aetna Commercial |
$181.21
|
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$197.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.37
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cash Price |
$277.49
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$386.34
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$129.40
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$113.22
|
| Rate for Payer: Cofinity Commercial |
$153.17
|
| Rate for Payer: Cofinity Commercial |
$149.23
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$183.34
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$163.02
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$242.80
|
| Rate for Payer: Cofinity Commercial |
$298.30
|
| Rate for Payer: Cofinity Commercial |
$338.05
|
| Rate for Payer: Cofinity Commercial |
$415.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.55
|
| Rate for Payer: Healthscope Commercial |
$145.57
|
| Rate for Payer: Healthscope Commercial |
$434.64
|
| Rate for Payer: Healthscope Commercial |
$312.17
|
| Rate for Payer: Healthscope Commercial |
$209.59
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Commercial |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$191.87
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.21
|
| Rate for Payer: PHP Commercial |
$294.83
|
| Rate for Payer: PHP Commercial |
$181.21
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: PHP Commercial |
$186.00
|
| Rate for Payer: PHP Commercial |
$410.49
|
| Rate for Payer: PHP Commercial |
$137.49
|
| Rate for Payer: PHP Commercial |
$197.95
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.57
|
| Rate for Payer: Priority Health SBD |
$134.31
|
| Rate for Payer: Priority Health SBD |
$114.11
|
| Rate for Payer: Priority Health SBD |
$101.90
|
| Rate for Payer: Priority Health SBD |
$137.86
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: Priority Health SBD |
$146.71
|
| Rate for Payer: Priority Health SBD |
$304.25
|
| Rate for Payer: Priority Health SBD |
$218.52
|
| Rate for Payer: UMR Bronson Commercial |
$93.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.28
|
| Rate for Payer: UMR Bronson Commercial |
$104.20
|
| Rate for Payer: UMR Bronson Commercial |
$152.62
|
| Rate for Payer: UMR Bronson Commercial |
$79.69
|
| Rate for Payer: UMR Bronson Commercial |
$212.49
|
| Rate for Payer: UMR Bronson Commercial |
$102.47
|
| Rate for Payer: UMR Bronson Commercial |
$71.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.66
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$346.86
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.34 |
| Max. Negotiated Rate |
$312.17 |
| Rate for Payer: Aetna American Axle |
$225.46
|
| Rate for Payer: Aetna American Axle |
$142.23
|
| Rate for Payer: Aetna American Axle |
$117.73
|
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna American Axle |
$198.41
|
| Rate for Payer: Aetna American Axle |
$138.57
|
| Rate for Payer: Aetna American Axle |
$105.14
|
| Rate for Payer: Aetna American Axle |
$312.21
|
| Rate for Payer: Aetna American Axle |
$225.06
|
| Rate for Payer: Aetna American Axle |
$175.09
|
| Rate for Payer: Aetna American Axle |
$313.90
|
| Rate for Payer: Aetna American Axle |
$205.07
|
| Rate for Payer: Aetna American Axle |
$151.37
|
| Rate for Payer: Aetna American Axle |
$274.23
|
| Rate for Payer: Aetna American Axle |
$358.59
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Commercial |
$268.18
|
| Rate for Payer: Aetna Commercial |
$410.49
|
| Rate for Payer: Aetna Commercial |
$197.95
|
| Rate for Payer: Aetna Commercial |
$358.61
|
| Rate for Payer: Aetna Commercial |
$181.21
|
| Rate for Payer: Aetna Commercial |
$259.46
|
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: Aetna Commercial |
$228.96
|
| Rate for Payer: Aetna Commercial |
$294.31
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Commercial |
$294.83
|
| Rate for Payer: Aetna Medicare |
$106.59
|
| Rate for Payer: Aetna Medicare |
$116.44
|
| Rate for Payer: Aetna Medicare |
$109.41
|
| Rate for Payer: Aetna Medicare |
$118.41
|
| Rate for Payer: Aetna Medicare |
$90.56
|
| Rate for Payer: Aetna Medicare |
$157.75
|
| Rate for Payer: Aetna Medicare |
$240.16
|
| Rate for Payer: Aetna Medicare |
$152.62
|
| Rate for Payer: Aetna Medicare |
$241.47
|
| Rate for Payer: Aetna Medicare |
$210.94
|
| Rate for Payer: Aetna Medicare |
$275.83
|
| Rate for Payer: Aetna Medicare |
$134.69
|
| Rate for Payer: Aetna Medicare |
$80.88
|
| Rate for Payer: Aetna Medicare |
$173.43
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.90
|
| Rate for Payer: BCBS Complete |
$64.70
|
| Rate for Payer: BCBS Complete |
$122.10
|
| Rate for Payer: BCBS Complete |
$87.53
|
| Rate for Payer: BCBS Complete |
$85.28
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Complete |
$220.67
|
| Rate for Payer: BCBS Complete |
$193.17
|
| Rate for Payer: BCBS Complete |
$192.13
|
| Rate for Payer: BCBS Complete |
$168.76
|
| Rate for Payer: BCBS Complete |
$93.15
|
| Rate for Payer: BCBS Complete |
$138.74
|
| Rate for Payer: BCBS Complete |
$94.73
|
| Rate for Payer: BCBS Complete |
$138.50
|
| Rate for Payer: BCBS Complete |
$107.75
|
| Rate for Payer: BCBS Complete |
$126.20
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$252.40
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$129.40
|
| Rate for Payer: Cash Price |
$337.51
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$386.34
|
| Rate for Payer: Cash Price |
$277.49
|
| Rate for Payer: Cofinity Commercial |
$163.02
|
| Rate for Payer: Cofinity Commercial |
$413.08
|
| Rate for Payer: Cofinity Commercial |
$338.05
|
| Rate for Payer: Cofinity Commercial |
$336.22
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$415.32
|
| Rate for Payer: Cofinity Commercial |
$298.30
|
| Rate for Payer: Cofinity Commercial |
$242.80
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Commercial |
$262.51
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$153.17
|
| Rate for Payer: Cofinity Commercial |
$149.23
|
| Rate for Payer: Cofinity Commercial |
$183.34
|
| Rate for Payer: Cofinity Commercial |
$113.22
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$213.68
|
| Rate for Payer: Cofinity Commercial |
$188.56
|
| Rate for Payer: Cofinity Commercial |
$231.66
|
| Rate for Payer: Cofinity Commercial |
$271.33
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Commercial |
$362.83
|
| Rate for Payer: Cofinity Commercial |
$295.32
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$297.77
|
| Rate for Payer: Cofinity Commercial |
$242.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| Rate for Payer: Healthscope Commercial |
$312.17
|
| Rate for Payer: Healthscope Commercial |
$311.62
|
| Rate for Payer: Healthscope Commercial |
$209.59
|
| Rate for Payer: Healthscope Commercial |
$274.73
|
| Rate for Payer: Healthscope Commercial |
$242.43
|
| Rate for Payer: Healthscope Commercial |
$432.29
|
| Rate for Payer: Healthscope Commercial |
$283.95
|
| Rate for Payer: Healthscope Commercial |
$434.64
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Healthscope Commercial |
$191.87
|
| Rate for Payer: Healthscope Commercial |
$145.57
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$379.70
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$413.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.95
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: PHP Commercial |
$228.96
|
| Rate for Payer: PHP Commercial |
$268.18
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: PHP Commercial |
$294.31
|
| Rate for Payer: PHP Commercial |
$197.95
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$294.83
|
| Rate for Payer: PHP Commercial |
$186.00
|
| Rate for Payer: PHP Commercial |
$358.61
|
| Rate for Payer: PHP Commercial |
$408.27
|
| Rate for Payer: PHP Commercial |
$181.21
|
| Rate for Payer: PHP Commercial |
$137.49
|
| Rate for Payer: PHP Commercial |
$410.49
|
| Rate for Payer: PHP Commercial |
$259.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.23
|
| Rate for Payer: Priority Health SBD |
$146.71
|
| Rate for Payer: Priority Health SBD |
$302.60
|
| Rate for Payer: Priority Health SBD |
$218.52
|
| Rate for Payer: Priority Health SBD |
$218.14
|
| Rate for Payer: Priority Health SBD |
$304.25
|
| Rate for Payer: Priority Health SBD |
$101.90
|
| Rate for Payer: Priority Health SBD |
$114.11
|
| Rate for Payer: Priority Health SBD |
$169.70
|
| Rate for Payer: Priority Health SBD |
$347.55
|
| Rate for Payer: Priority Health SBD |
$198.76
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: Priority Health SBD |
$192.31
|
| Rate for Payer: Priority Health SBD |
$134.31
|
| Rate for Payer: Priority Health SBD |
$265.79
|
| Rate for Payer: Priority Health SBD |
$137.86
|
| Rate for Payer: UMR Bronson Commercial |
$128.34
|
| Rate for Payer: UMR Bronson Commercial |
$177.72
|
| Rate for Payer: UMR Bronson Commercial |
$116.73
|
| Rate for Payer: UMR Bronson Commercial |
$112.94
|
| Rate for Payer: UMR Bronson Commercial |
$204.12
|
| Rate for Payer: UMR Bronson Commercial |
$86.17
|
| Rate for Payer: UMR Bronson Commercial |
$128.11
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
| Rate for Payer: UMR Bronson Commercial |
$178.68
|
| Rate for Payer: UMR Bronson Commercial |
$99.67
|
| Rate for Payer: UMR Bronson Commercial |
$87.62
|
| Rate for Payer: UMR Bronson Commercial |
$156.10
|
| Rate for Payer: UMR Bronson Commercial |
$67.01
|
| Rate for Payer: UMR Bronson Commercial |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$78.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$413.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.94
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$202.73
|
|
|
Service Code
|
NDC 55150045901
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$89.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$169.68
|
|
|
Service Code
|
NDC 71839013710
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$74.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$195.73
|
|
|
Service Code
|
NDC 70121168007
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna Medicare |
$97.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: BCBS Complete |
$78.29
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna American Axle |
$101.76
|
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna Medicare |
$78.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
| Rate for Payer: UMR Bronson Commercial |
$57.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.42
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna American Axle |
$106.98
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: UMR Bronson Commercial |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.44
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$195.73
|
|
|
Service Code
|
NDC 70121168001
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna American Axle |
$285.36
|
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
| Rate for Payer: UMR Bronson Commercial |
$193.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$202.73
|
|
|
Service Code
|
NDC 55150045910
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$89.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$439.02
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$395.12 |
| Rate for Payer: Aetna American Axle |
$285.36
|
| Rate for Payer: Aetna Commercial |
$373.17
|
| Rate for Payer: Aetna Medicare |
$219.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.36
|
| Rate for Payer: BCBS Complete |
$175.61
|
| Rate for Payer: Cash Price |
$351.22
|
| Rate for Payer: Cofinity Commercial |
$307.31
|
| Rate for Payer: Cofinity Commercial |
$377.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.22
|
| Rate for Payer: Healthscope Commercial |
$395.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.17
|
| Rate for Payer: PHP Commercial |
$373.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.36
|
| Rate for Payer: Priority Health SBD |
$276.58
|
| Rate for Payer: UMR Bronson Commercial |
$162.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$202.73
|
|
|
Service Code
|
NDC 55150045901
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$182.46 |
| Rate for Payer: Aetna American Axle |
$131.77
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Medicare |
$101.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.77
|
| Rate for Payer: BCBS Complete |
$81.09
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cofinity Commercial |
$141.91
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.18
|
| Rate for Payer: Healthscope Commercial |
$182.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.32
|
| Rate for Payer: PHP Commercial |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.77
|
| Rate for Payer: Priority Health SBD |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$75.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.05
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$164.59
|
|
|
Service Code
|
NDC 43598069858
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna American Axle |
$106.98
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna Medicare |
$82.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.98
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: UMR Bronson Commercial |
$60.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.44
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$169.68
|
|
|
Service Code
|
NDC 71839013710
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna Medicare |
$84.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: BCBS Complete |
$67.87
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$169.68
|
|
|
Service Code
|
NDC 71839013701
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Aetna American Axle |
$110.29
|
| Rate for Payer: Aetna Commercial |
$144.23
|
| Rate for Payer: Aetna Medicare |
$84.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.29
|
| Rate for Payer: BCBS Complete |
$67.87
|
| Rate for Payer: Cash Price |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$118.78
|
| Rate for Payer: Cofinity Commercial |
$145.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$152.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.23
|
| Rate for Payer: PHP Commercial |
$144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.29
|
| Rate for Payer: Priority Health SBD |
$106.90
|
| Rate for Payer: UMR Bronson Commercial |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.26
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$195.73
|
|
|
Service Code
|
NDC 70121168007
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna American Axle |
$127.22
|
| Rate for Payer: Aetna Commercial |
$166.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.22
|
| Rate for Payer: Cash Price |
$156.58
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.58
|
| Rate for Payer: Healthscope Commercial |
$176.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.37
|
| Rate for Payer: PHP Commercial |
$166.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.22
|
| Rate for Payer: Priority Health SBD |
$123.31
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$165.34
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$148.81 |
| Rate for Payer: Aetna American Axle |
$107.47
|
| Rate for Payer: Aetna Commercial |
$140.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.47
|
| Rate for Payer: Cash Price |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$115.74
|
| Rate for Payer: Cofinity Commercial |
$142.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.54
|
| Rate for Payer: PHP Commercial |
$140.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$72.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$165.34
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$148.81 |
| Rate for Payer: Aetna American Axle |
$107.47
|
| Rate for Payer: Aetna Commercial |
$140.54
|
| Rate for Payer: Aetna Medicare |
$82.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.47
|
| Rate for Payer: BCBS Complete |
$66.14
|
| Rate for Payer: Cash Price |
$132.27
|
| Rate for Payer: Cofinity Commercial |
$115.74
|
| Rate for Payer: Cofinity Commercial |
$142.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.27
|
| Rate for Payer: Healthscope Commercial |
$148.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.54
|
| Rate for Payer: PHP Commercial |
$140.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$156.56
|
|
|
Service Code
|
NDC 43598069811
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Aetna American Axle |
$101.76
|
| Rate for Payer: Aetna Commercial |
$133.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: Cash Price |
$125.25
|
| Rate for Payer: Cofinity Commercial |
$109.59
|
| Rate for Payer: Cofinity Commercial |
$134.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$140.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.08
|
| Rate for Payer: PHP Commercial |
$133.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: Priority Health SBD |
$98.63
|
| Rate for Payer: UMR Bronson Commercial |
$68.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.42
|
|
