|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$192.70
|
|
|
Service Code
|
NDC 0093-9702-01
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.26
|
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.26
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.80
|
| Rate for Payer: PHP Commercial |
$163.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.89
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UMR Bronson Commercial |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 62756-518-88
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.87
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.54
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UMR Bronson Commercial |
$115.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 63739-108-10
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 0904-6237-61
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 0904-7257-61
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$154.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
NDC 0006-3916-68
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.26 |
| Max. Negotiated Rate |
$473.04 |
| Rate for Payer: Aetna American Axle |
$341.64
|
| Rate for Payer: Aetna Commercial |
$446.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.64
|
| Rate for Payer: Cash Price |
$420.48
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Cofinity Commercial |
$452.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.48
|
| Rate for Payer: Healthscope Commercial |
$473.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.76
|
| Rate for Payer: PHP Commercial |
$446.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.92
|
| Rate for Payer: Priority Health SBD |
$331.13
|
| Rate for Payer: UMR Bronson Commercial |
$231.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.20
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$220.90
|
|
|
Service Code
|
NDC 69367-339-01
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna American Axle |
$143.58
|
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health SBD |
$139.17
|
| Rate for Payer: UMR Bronson Commercial |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$1,244.50
|
|
|
Service Code
|
NDC 62756-518-13
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.58 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna American Axle |
$808.92
|
| Rate for Payer: Aetna Commercial |
$1,057.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.92
|
| Rate for Payer: Cash Price |
$995.60
|
| Rate for Payer: Cofinity Commercial |
$1,070.27
|
| Rate for Payer: Cofinity Commercial |
$871.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$995.60
|
| Rate for Payer: Healthscope Commercial |
$1,120.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$871.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$933.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,057.82
|
| Rate for Payer: PHP Commercial |
$1,057.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.15
|
| Rate for Payer: Priority Health SBD |
$784.04
|
| Rate for Payer: UMR Bronson Commercial |
$547.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$933.38
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
NDC 68084-093-11
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna American Axle |
$1.32
|
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.32
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
| Rate for Payer: Priority Health SBD |
$1.28
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 68084-094-11
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.94
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 0904-6238-61
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.32
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
CARBIDOPA 4.63 MG-LEVODOPA 20 MG/ML SUSPENSION IN J-TUBE PUMP
|
Facility
|
IP
|
$807.71
|
|
|
Service Code
|
HCPCS J7340
|
| Hospital Charge Code |
174006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$355.39 |
| Max. Negotiated Rate |
$726.94 |
| Rate for Payer: Aetna American Axle |
$525.01
|
| Rate for Payer: Aetna Commercial |
$686.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.01
|
| Rate for Payer: Cash Price |
$646.17
|
| Rate for Payer: Cofinity Commercial |
$565.40
|
| Rate for Payer: Cofinity Commercial |
$694.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.17
|
| Rate for Payer: Healthscope Commercial |
$726.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.55
|
| Rate for Payer: PHP Commercial |
$686.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.40
|
| Rate for Payer: Priority Health SBD |
$508.86
|
| Rate for Payer: UMR Bronson Commercial |
$355.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.78
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 51079-978-01
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$331.55
|
|
|
Service Code
|
NDC 62756-461-88
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$298.40 |
| Rate for Payer: Aetna American Axle |
$215.51
|
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$232.08
|
| Rate for Payer: Cofinity Commercial |
$285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$298.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: PHP Commercial |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: Priority Health SBD |
$208.88
|
| Rate for Payer: UMR Bronson Commercial |
$145.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.66
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 68084-281-11
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.87
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 51079-978-20
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 62756-457-88
|
| 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: 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 Multiplan/Beech St/PHCS |
$265.61
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| 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
|
IP
|
$627.36
|
|
|
Service Code
|
NDC 0378-0094-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$533.26
|
| Rate for Payer: PHP Commercial |
$533.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.15
|
| 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
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$161.75
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$145.58 |
| Rate for Payer: Aetna American Axle |
$105.14
|
| Rate for Payer: Aetna American Axle |
$138.57
|
| Rate for Payer: Aetna American Axle |
$330.40
|
| Rate for Payer: Aetna American Axle |
$240.45
|
| Rate for Payer: Aetna American Axle |
$214.67
|
| Rate for Payer: Aetna American Axle |
$183.19
|
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna American Axle |
$142.23
|
| Rate for Payer: Aetna American Axle |
$117.73
|
| Rate for Payer: Aetna Commercial |
$181.21
|
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$239.56
|
| Rate for Payer: Aetna Commercial |
$280.72
|
| Rate for Payer: Aetna Commercial |
$314.44
|
| Rate for Payer: Aetna Commercial |
$432.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.57
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$406.64
|
| Rate for Payer: Cash Price |
$295.94
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$129.40
|
| Rate for Payer: Cash Price |
$264.21
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cash Price |
$225.46
|
| Rate for Payer: Cofinity Commercial |
$149.23
|
| Rate for Payer: Cofinity Commercial |
$183.34
|
| Rate for Payer: Cofinity Commercial |
$153.17
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$318.14
|
| Rate for Payer: Cofinity Commercial |
$258.95
|
| Rate for Payer: Cofinity Commercial |
$197.28
|
| Rate for Payer: Cofinity Commercial |
$355.81
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$437.14
|
| Rate for Payer: Cofinity Commercial |
$284.02
|
| Rate for Payer: Cofinity Commercial |
$231.18
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$113.22
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| 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 |
$406.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Healthscope Commercial |
$191.87
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$145.58
|
| Rate for Payer: Healthscope Commercial |
$196.94
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Commercial |
$253.65
|
| Rate for Payer: Healthscope Commercial |
$297.23
|
| Rate for Payer: Healthscope Commercial |
$332.94
|
| Rate for Payer: Healthscope Commercial |
$457.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.45
|
| 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 |
$247.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.72
|
| Rate for Payer: PHP Commercial |
$239.56
|
| Rate for Payer: PHP Commercial |
$186.00
|
| Rate for Payer: PHP Commercial |
$181.21
|
| Rate for Payer: PHP Commercial |
$137.49
|
| Rate for Payer: PHP Commercial |
$280.72
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: PHP Commercial |
$314.44
|
| Rate for Payer: PHP Commercial |
$432.06
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.22
|
| Rate for Payer: Priority Health SBD |
$208.06
|
| Rate for Payer: Priority Health SBD |
$320.23
|
| Rate for Payer: Priority Health SBD |
$114.11
|
| Rate for Payer: Priority Health SBD |
$137.86
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: Priority Health SBD |
$101.90
|
| Rate for Payer: Priority Health SBD |
$233.06
|
| Rate for Payer: Priority Health SBD |
$177.55
|
| Rate for Payer: Priority Health SBD |
$134.31
|
| Rate for Payer: UMR Bronson Commercial |
$71.17
|
| Rate for Payer: UMR Bronson Commercial |
$79.69
|
| Rate for Payer: UMR Bronson Commercial |
$104.20
|
| Rate for Payer: UMR Bronson Commercial |
$162.77
|
| Rate for Payer: UMR Bronson Commercial |
$223.65
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: UMR Bronson Commercial |
$96.28
|
| Rate for Payer: UMR Bronson Commercial |
$93.80
|
| Rate for Payer: UMR Bronson Commercial |
$124.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.84
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$305.25
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$274.72 |
| Rate for Payer: Aetna American Axle |
$198.41
|
| Rate for Payer: Aetna American Axle |
$358.59
|
| Rate for Payer: Aetna American Axle |
$117.73
|
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna American Axle |
$205.08
|
| Rate for Payer: Aetna American Axle |
$272.63
|
| Rate for Payer: Aetna American Axle |
$175.09
|
| Rate for Payer: Aetna American Axle |
$312.21
|
| Rate for Payer: Aetna American Axle |
$274.23
|
| Rate for Payer: Aetna Commercial |
$358.61
|
| Rate for Payer: Aetna Commercial |
$228.96
|
| Rate for Payer: Aetna Commercial |
$153.95
|
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Commercial |
$201.30
|
| Rate for Payer: Aetna Commercial |
$259.46
|
| Rate for Payer: Aetna Commercial |
$356.52
|
| Rate for Payer: Aetna Commercial |
$268.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.59
|
| Rate for Payer: BCBS Complete |
$168.76
|
| Rate for Payer: BCBS Complete |
$107.75
|
| Rate for Payer: BCBS Complete |
$94.73
|
| Rate for Payer: BCBS Complete |
$220.67
|
| Rate for Payer: BCBS Complete |
$167.77
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Complete |
$126.20
|
| Rate for Payer: BCBS Complete |
$122.10
|
| Rate for Payer: BCBS Complete |
$192.13
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$189.46
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$252.40
|
| Rate for Payer: Cash Price |
$252.40
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$337.51
|
| Rate for Payer: Cash Price |
$337.51
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cash Price |
$384.26
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cash Price |
$441.34
|
| Rate for Payer: Cofinity Commercial |
$262.52
|
| Rate for Payer: Cofinity Commercial |
$295.32
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$413.08
|
| Rate for Payer: Cofinity Commercial |
$336.22
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$155.76
|
| Rate for Payer: Cofinity Commercial |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$213.68
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$386.17
|
| Rate for Payer: Cofinity Commercial |
$188.56
|
| Rate for Payer: Cofinity Commercial |
$231.66
|
| Rate for Payer: Cofinity Commercial |
$474.44
|
| Rate for Payer: Cofinity Commercial |
$271.33
|
| Rate for Payer: Cofinity Commercial |
$362.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.34
|
| 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 |
$244.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.51
|
| Rate for Payer: Healthscope Commercial |
$283.95
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Healthscope Commercial |
$379.70
|
| Rate for Payer: Healthscope Commercial |
$242.43
|
| Rate for Payer: Healthscope Commercial |
$274.72
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Healthscope Commercial |
$432.29
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$413.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.96
|
| Rate for Payer: PHP Commercial |
$259.46
|
| Rate for Payer: PHP Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$268.18
|
| Rate for Payer: PHP Commercial |
$408.27
|
| Rate for Payer: PHP Commercial |
$358.61
|
| Rate for Payer: PHP Commercial |
$153.95
|
| Rate for Payer: PHP Commercial |
$468.92
|
| Rate for Payer: PHP Commercial |
$201.30
|
| Rate for Payer: PHP Commercial |
$228.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.17
|
| Rate for Payer: Priority Health SBD |
$169.70
|
| Rate for Payer: Priority Health SBD |
$347.55
|
| Rate for Payer: Priority Health SBD |
$114.11
|
| Rate for Payer: Priority Health SBD |
$265.79
|
| Rate for Payer: Priority Health SBD |
$264.24
|
| Rate for Payer: Priority Health SBD |
$302.60
|
| Rate for Payer: Priority Health SBD |
$192.31
|
| Rate for Payer: Priority Health SBD |
$198.76
|
| Rate for Payer: Priority Health SBD |
$149.20
|
| Rate for Payer: UMR Bronson Commercial |
$99.67
|
| Rate for Payer: UMR Bronson Commercial |
$177.72
|
| Rate for Payer: UMR Bronson Commercial |
$112.94
|
| Rate for Payer: UMR Bronson Commercial |
$204.12
|
| Rate for Payer: UMR Bronson Commercial |
$67.01
|
| Rate for Payer: UMR Bronson Commercial |
$87.62
|
| Rate for Payer: UMR Bronson Commercial |
$156.10
|
| Rate for Payer: UMR Bronson Commercial |
$155.19
|
| Rate for Payer: UMR Bronson Commercial |
$116.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$413.75
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$256.53
|
|
|
Service Code
|
NDC 0009-0856-08
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.87 |
| Max. Negotiated Rate |
$230.88 |
| Rate for Payer: Aetna American Axle |
$166.74
|
| Rate for Payer: Aetna Commercial |
$218.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.74
|
| Rate for Payer: Cash Price |
$205.22
|
| Rate for Payer: Cofinity Commercial |
$179.57
|
| Rate for Payer: Cofinity Commercial |
$220.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.22
|
| Rate for Payer: Healthscope Commercial |
$230.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.05
|
| Rate for Payer: PHP Commercial |
$218.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.57
|
| Rate for Payer: Priority Health SBD |
$161.61
|
| Rate for Payer: UMR Bronson Commercial |
$112.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.40
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Aetna American Axle |
$191.51
|
| Rate for Payer: Aetna Commercial |
$250.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.51
|
| Rate for Payer: Cash Price |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$253.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.70
|
| Rate for Payer: Healthscope Commercial |
$265.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.44
|
| Rate for Payer: PHP Commercial |
$250.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.24
|
| Rate for Payer: Priority Health SBD |
$185.62
|
| Rate for Payer: UMR Bronson Commercial |
$129.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.97
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$222.40
|
|
|
Service Code
|
NDC 55150-459-10
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$200.16 |
| Rate for Payer: Aetna American Axle |
$144.56
|
| Rate for Payer: Aetna Commercial |
$189.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.56
|
| Rate for Payer: Cash Price |
$177.92
|
| Rate for Payer: Cofinity Commercial |
$155.68
|
| Rate for Payer: Cofinity Commercial |
$191.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.92
|
| Rate for Payer: Healthscope Commercial |
$200.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.04
|
| Rate for Payer: PHP Commercial |
$189.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.68
|
| Rate for Payer: Priority Health SBD |
$140.11
|
| Rate for Payer: UMR Bronson Commercial |
$97.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.80
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$285.03
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.41 |
| Max. Negotiated Rate |
$256.53 |
| Rate for Payer: Aetna American Axle |
$185.27
|
| Rate for Payer: Aetna Commercial |
$242.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.27
|
| Rate for Payer: Cash Price |
$228.02
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Cofinity Commercial |
$245.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.02
|
| Rate for Payer: Healthscope Commercial |
$256.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.28
|
| Rate for Payer: PHP Commercial |
$242.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.52
|
| Rate for Payer: Priority Health SBD |
$179.57
|
| Rate for Payer: UMR Bronson Commercial |
$125.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.77
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$222.40
|
|
|
Service Code
|
NDC 55150-459-01
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$200.16 |
| Rate for Payer: Aetna American Axle |
$144.56
|
| Rate for Payer: Aetna Commercial |
$189.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.56
|
| Rate for Payer: Cash Price |
$177.92
|
| Rate for Payer: Cofinity Commercial |
$155.68
|
| Rate for Payer: Cofinity Commercial |
$191.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.92
|
| Rate for Payer: Healthscope Commercial |
$200.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.04
|
| Rate for Payer: PHP Commercial |
$189.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.68
|
| Rate for Payer: Priority Health SBD |
$140.11
|
| Rate for Payer: UMR Bronson Commercial |
$97.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.80
|
|
