|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,880.42
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,987.38 |
| Max. Negotiated Rate |
$14,292.38 |
| Rate for Payer: Aetna American Axle |
$10,322.27
|
| Rate for Payer: Aetna Commercial |
$13,498.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,322.27
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cofinity Commercial |
$11,116.29
|
| Rate for Payer: Cofinity Commercial |
$13,657.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,116.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,704.34
|
| Rate for Payer: Healthscope Commercial |
$14,292.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,116.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,910.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,498.36
|
| Rate for Payer: PHP Commercial |
$13,498.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,322.27
|
| Rate for Payer: Priority Health SBD |
$10,004.66
|
| Rate for Payer: UMR Bronson Commercial |
$6,987.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,910.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,880.42
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$14,292.38 |
| Rate for Payer: Aetna American Axle |
$10,322.27
|
| Rate for Payer: Aetna Commercial |
$13,498.36
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,322.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.96
|
| Rate for Payer: BCBS Complete |
$29.25
|
| Rate for Payer: BCBS MAPPO |
$51.97
|
| Rate for Payer: BCBS Trust/PPO |
$131.18
|
| Rate for Payer: BCN Commercial |
$131.18
|
| Rate for Payer: BCN Medicare Advantage |
$51.97
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cash Price |
$12,704.34
|
| Rate for Payer: Cofinity Commercial |
$13,657.16
|
| Rate for Payer: Cofinity Commercial |
$11,116.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,116.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,704.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.97
|
| Rate for Payer: Healthscope Commercial |
$14,292.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,116.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,910.32
|
| Rate for Payer: Mclaren Medicaid |
$27.86
|
| Rate for Payer: Mclaren Medicare |
$51.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$29.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,498.36
|
| Rate for Payer: Nomi Health Commercial |
$155.91
|
| Rate for Payer: PACE Medicare |
$49.37
|
| Rate for Payer: PACE SWMI |
$51.97
|
| Rate for Payer: PHP Commercial |
$13,498.36
|
| Rate for Payer: PHP Medicare Advantage |
$51.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,322.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.69
|
| Rate for Payer: Priority Health Medicare |
$51.97
|
| Rate for Payer: Priority Health Narrow Network |
$114.15
|
| Rate for Payer: Priority Health SBD |
$10,004.66
|
| Rate for Payer: Railroad Medicare Medicare |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.97
|
| Rate for Payer: UHC Exchange |
$99.32
|
| Rate for Payer: UHC Medicare Advantage |
$51.97
|
| Rate for Payer: UHCCP Medicaid |
$27.86
|
| Rate for Payer: UMR Bronson Commercial |
$5,875.76
|
| Rate for Payer: VA VA |
$51.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,910.32
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Medicare |
$1,741.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: BCBS Complete |
$1,393.04
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.84
|
| Rate for Payer: Aetna Commercial |
$1,480.10
|
| Rate for Payer: Aetna Medicare |
$870.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.84
|
| Rate for Payer: BCBS Complete |
$696.52
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.10
|
| Rate for Payer: PHP Commercial |
$1,480.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.84
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$644.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.98
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.84
|
| Rate for Payer: Aetna Commercial |
$1,480.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.84
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.10
|
| Rate for Payer: PHP Commercial |
$1,480.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.84
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$766.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.98
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,932.84 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna Medicare |
$2,611.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: BCBS Complete |
$2,089.56
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,932.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874011530
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,298.51 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,298.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874011520
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,532.34 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,932.84 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna Medicare |
$2,611.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: BCBS Complete |
$2,089.56
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,932.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.84
|
| Rate for Payer: Aetna Commercial |
$1,480.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.84
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.10
|
| Rate for Payer: PHP Commercial |
$1,480.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.84
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$766.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.98
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Medicare |
$1,741.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: BCBS Complete |
$1,393.04
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,741.30
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$1,567.17 |
| Rate for Payer: Aetna American Axle |
$1,131.84
|
| Rate for Payer: Aetna Commercial |
$1,480.10
|
| Rate for Payer: Aetna Medicare |
$870.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.84
|
| Rate for Payer: BCBS Complete |
$696.52
|
| Rate for Payer: Cash Price |
$1,393.04
|
| Rate for Payer: Cofinity Commercial |
$1,218.91
|
| Rate for Payer: Cofinity Commercial |
$1,497.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,218.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.04
|
| Rate for Payer: Healthscope Commercial |
$1,567.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.10
|
| Rate for Payer: PHP Commercial |
$1,480.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.84
|
| Rate for Payer: Priority Health SBD |
$1,097.02
|
| Rate for Payer: UMR Bronson Commercial |
$644.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.98
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$3,482.59
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,532.34 |
| Max. Negotiated Rate |
$3,134.33 |
| Rate for Payer: Aetna American Axle |
$2,263.68
|
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.68
|
| Rate for Payer: Cash Price |
$2,786.07
|
| Rate for Payer: Cofinity Commercial |
$2,437.81
|
| Rate for Payer: Cofinity Commercial |
$2,995.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,437.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,786.07
|
| Rate for Payer: Healthscope Commercial |
$3,134.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,437.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,960.20
|
| Rate for Payer: PHP Commercial |
$2,960.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,263.68
|
| Rate for Payer: Priority Health SBD |
$2,194.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.94
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$5,223.89
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,298.51 |
| Max. Negotiated Rate |
$4,701.50 |
| Rate for Payer: Aetna American Axle |
$3,395.53
|
| Rate for Payer: Aetna Commercial |
$4,440.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,395.53
|
| Rate for Payer: Cash Price |
$4,179.11
|
| Rate for Payer: Cofinity Commercial |
$3,656.72
|
| Rate for Payer: Cofinity Commercial |
$4,492.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,656.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,179.11
|
| Rate for Payer: Healthscope Commercial |
$4,701.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,656.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,917.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,440.31
|
| Rate for Payer: PHP Commercial |
$4,440.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,395.53
|
| Rate for Payer: Priority Health SBD |
$3,291.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,298.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,917.92
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,545.86
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
28911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,080.18 |
| Max. Negotiated Rate |
$10,391.27 |
| Rate for Payer: Aetna American Axle |
$7,504.81
|
| Rate for Payer: Aetna American Axle |
$533.84
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| Rate for Payer: Aetna Commercial |
$698.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,504.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.84
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| Rate for Payer: Cofinity Commercial |
$574.91
|
| Rate for Payer: Cofinity Commercial |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,082.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,236.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.04
|
| Rate for Payer: Healthscope Commercial |
$10,391.27
|
| Rate for Payer: Healthscope Commercial |
$739.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,082.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,659.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,813.98
|
| Rate for Payer: PHP Commercial |
$698.10
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,504.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.84
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: UMR Bronson Commercial |
$5,080.18
|
| Rate for Payer: UMR Bronson Commercial |
$361.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,659.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.98
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,545.86
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
28911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$10,391.27 |
| Rate for Payer: Mclaren Medicaid |
$136.85
|
| Rate for Payer: Mclaren Medicare |
$255.32
|
| Rate for Payer: Mclaren Medicare |
$255.32
|
| Rate for Payer: Aetna American Axle |
$7,504.81
|
| Rate for Payer: Aetna American Axle |
$533.84
|
| Rate for Payer: Aetna Commercial |
$698.10
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| Rate for Payer: Aetna Medicare |
$265.53
|
| Rate for Payer: Aetna Medicare |
$265.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,504.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.15
|
| Rate for Payer: BCBS Complete |
$143.69
|
| Rate for Payer: BCBS Complete |
$143.69
|
| Rate for Payer: BCBS MAPPO |
$255.32
|
| Rate for Payer: BCBS MAPPO |
$255.32
|
| Rate for Payer: BCBS Trust/PPO |
$892.13
|
| Rate for Payer: BCBS Trust/PPO |
$892.13
|
| Rate for Payer: BCN Commercial |
$892.13
|
| Rate for Payer: BCN Commercial |
$892.13
|
| Rate for Payer: BCN Medicare Advantage |
$255.32
|
| Rate for Payer: BCN Medicare Advantage |
$255.32
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cofinity Commercial |
$574.91
|
| Rate for Payer: Cofinity Commercial |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,082.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$574.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,236.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.32
|
| Rate for Payer: Healthscope Commercial |
$10,391.27
|
| Rate for Payer: Healthscope Commercial |
$739.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,082.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,659.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.98
|
| Rate for Payer: Mclaren Medicaid |
$136.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.09
|
| Rate for Payer: Meridian Medicaid |
$143.69
|
| Rate for Payer: Meridian Medicaid |
$143.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,813.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.10
|
| Rate for Payer: Nomi Health Commercial |
$765.96
|
| Rate for Payer: Nomi Health Commercial |
$765.96
|
| Rate for Payer: PACE Medicare |
$242.55
|
| Rate for Payer: PACE Medicare |
$242.55
|
| Rate for Payer: PACE SWMI |
$255.32
|
| Rate for Payer: PACE SWMI |
$255.32
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: PHP Commercial |
$698.10
|
| Rate for Payer: PHP Medicare Advantage |
$255.32
|
| Rate for Payer: PHP Medicare Advantage |
$255.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,504.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.25
|
| Rate for Payer: Priority Health Medicare |
$255.32
|
| Rate for Payer: Priority Health Medicare |
$255.32
|
| Rate for Payer: Priority Health Narrow Network |
$761.80
|
| Rate for Payer: Priority Health Narrow Network |
$761.80
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: Railroad Medicare Medicare |
$255.32
|
| Rate for Payer: Railroad Medicare Medicare |
$255.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.32
|
| Rate for Payer: UHC Exchange |
$487.94
|
| Rate for Payer: UHC Exchange |
$487.94
|
| Rate for Payer: UHC Medicare Advantage |
$255.32
|
| Rate for Payer: UHC Medicare Advantage |
$255.32
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: UMR Bronson Commercial |
$4,271.97
|
| Rate for Payer: UMR Bronson Commercial |
$303.88
|
| Rate for Payer: VA VA |
$255.32
|
| Rate for Payer: VA VA |
$255.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,659.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.98
|
|
|
CARMUSTINE IN POLIFEPROSAN 7.7 MG WAFER FOR IMPLANT
|
Facility
|
OP
|
$143,383.38
|
|
|
Service Code
|
NDC 24338005008
|
| Hospital Charge Code |
21672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53,051.85 |
| Max. Negotiated Rate |
$129,045.04 |
| Rate for Payer: Aetna American Axle |
$93,199.20
|
| Rate for Payer: Aetna Commercial |
$121,875.87
|
| Rate for Payer: Aetna Medicare |
$71,691.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93,199.20
|
| Rate for Payer: BCBS Complete |
$57,353.35
|
| Rate for Payer: Cash Price |
$114,706.70
|
| Rate for Payer: Cofinity Commercial |
$100,368.37
|
| Rate for Payer: Cofinity Commercial |
$123,309.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$100,368.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114,706.70
|
| Rate for Payer: Healthscope Commercial |
$129,045.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100,368.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107,537.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121,875.87
|
| Rate for Payer: PHP Commercial |
$121,875.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93,199.20
|
| Rate for Payer: Priority Health SBD |
$90,331.53
|
| Rate for Payer: UMR Bronson Commercial |
$53,051.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107,537.54
|
|
|
CARMUSTINE IN POLIFEPROSAN 7.7 MG WAFER FOR IMPLANT
|
Facility
|
IP
|
$143,383.38
|
|
|
Service Code
|
NDC 24338005008
|
| Hospital Charge Code |
21672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63,088.69 |
| Max. Negotiated Rate |
$129,045.04 |
| Rate for Payer: Aetna American Axle |
$93,199.20
|
| Rate for Payer: Aetna Commercial |
$121,875.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93,199.20
|
| Rate for Payer: Cash Price |
$114,706.70
|
| Rate for Payer: Cofinity Commercial |
$100,368.37
|
| Rate for Payer: Cofinity Commercial |
$123,309.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$100,368.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114,706.70
|
| Rate for Payer: Healthscope Commercial |
$129,045.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100,368.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107,537.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121,875.87
|
| Rate for Payer: PHP Commercial |
$121,875.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93,199.20
|
| Rate for Payer: Priority Health SBD |
$90,331.53
|
| Rate for Payer: UMR Bronson Commercial |
$63,088.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107,537.54
|
|
|
CARPECTOMY; 1 BONE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.45
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$479.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$601.61 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.77
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$601.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$11,273.70
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$464.01 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.09
|
| Rate for Payer: BCN Commercial |
$2,108.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.41
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$464.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 51079093101
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904730761
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
