|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,044.05
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,179.38 |
| Max. Negotiated Rate |
$12,639.64 |
| Rate for Payer: Aetna American Axle |
$9,128.63
|
| Rate for Payer: Aetna Commercial |
$11,937.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,128.63
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cofinity Commercial |
$12,077.88
|
| Rate for Payer: Cofinity Commercial |
$9,830.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,235.24
|
| Rate for Payer: Healthscope Commercial |
$12,639.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,830.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,533.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,937.44
|
| Rate for Payer: PHP Commercial |
$11,937.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,830.84
|
| Rate for Payer: Priority Health SBD |
$8,847.75
|
| Rate for Payer: UMR Bronson Commercial |
$6,179.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,533.04
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,044.05
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$12,639.64 |
| Rate for Payer: Aetna American Axle |
$9,128.63
|
| Rate for Payer: Aetna Commercial |
$11,937.44
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,128.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.86
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: BCBS MAPPO |
$47.08
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Medicare Advantage |
$47.08
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cofinity Commercial |
$9,830.84
|
| Rate for Payer: Cofinity Commercial |
$12,077.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,235.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.08
|
| Rate for Payer: Healthscope Commercial |
$12,639.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,830.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,533.04
|
| Rate for Payer: Mclaren Medicaid |
$25.76
|
| Rate for Payer: Mclaren Medicare |
$47.08
|
| Rate for Payer: Meridian Medicaid |
$27.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,937.44
|
| Rate for Payer: PACE Medicare |
$44.73
|
| Rate for Payer: PACE SWMI |
$47.08
|
| Rate for Payer: PHP Commercial |
$11,937.44
|
| Rate for Payer: PHP Medicare Advantage |
$47.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,830.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.73
|
| Rate for Payer: Priority Health Medicare |
$47.08
|
| Rate for Payer: Priority Health Narrow Network |
$110.18
|
| Rate for Payer: Priority Health SBD |
$8,847.75
|
| Rate for Payer: Railroad Medicare Medicare |
$47.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.08
|
| Rate for Payer: UHC Medicare Advantage |
$48.50
|
| Rate for Payer: UMR Bronson Commercial |
$5,196.30
|
| Rate for Payer: VA VA |
$47.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,533.04
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,579.42
|
|
|
Service Code
|
NDC 61874-115-11
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$694.94 |
| Max. Negotiated Rate |
$1,421.48 |
| Rate for Payer: Aetna American Axle |
$1,026.62
|
| Rate for Payer: Aetna Commercial |
$1,342.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.62
|
| Rate for Payer: Cash Price |
$1,263.54
|
| Rate for Payer: Cofinity Commercial |
$1,105.59
|
| Rate for Payer: Cofinity Commercial |
$1,358.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.54
|
| Rate for Payer: Healthscope Commercial |
$1,421.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,105.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.51
|
| Rate for Payer: PHP Commercial |
$1,342.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.59
|
| Rate for Payer: Priority Health SBD |
$995.03
|
| Rate for Payer: UMR Bronson Commercial |
$694.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.56
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,158.84
|
|
|
Service Code
|
NDC 61874-115-20
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,389.89 |
| Max. Negotiated Rate |
$2,842.96 |
| Rate for Payer: Aetna American Axle |
$2,053.25
|
| Rate for Payer: Aetna Commercial |
$2,685.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,053.25
|
| Rate for Payer: Cash Price |
$2,527.07
|
| Rate for Payer: Cofinity Commercial |
$2,211.19
|
| Rate for Payer: Cofinity Commercial |
$2,716.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,527.07
|
| Rate for Payer: Healthscope Commercial |
$2,842.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,369.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,685.01
|
| Rate for Payer: PHP Commercial |
$2,685.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,211.19
|
| Rate for Payer: Priority Health SBD |
$1,990.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,369.13
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$4,738.15
|
|
|
Service Code
|
NDC 61874-115-30
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,084.79 |
| Max. Negotiated Rate |
$4,264.34 |
| Rate for Payer: Aetna American Axle |
$3,079.80
|
| Rate for Payer: Aetna Commercial |
$4,027.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,079.80
|
| Rate for Payer: Cash Price |
$3,790.52
|
| Rate for Payer: Cofinity Commercial |
$3,316.70
|
| Rate for Payer: Cofinity Commercial |
$4,074.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,790.52
|
| Rate for Payer: Healthscope Commercial |
$4,264.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,316.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,553.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,027.43
|
| Rate for Payer: PHP Commercial |
$4,027.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.70
|
| Rate for Payer: Priority Health SBD |
$2,985.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,084.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.61
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$3,158.84
|
|
|
Service Code
|
NDC 61874-130-20
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,389.89 |
| Max. Negotiated Rate |
$2,842.96 |
| Rate for Payer: Aetna American Axle |
$2,053.25
|
| Rate for Payer: Aetna Commercial |
$2,685.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,053.25
|
| Rate for Payer: Cash Price |
$2,527.07
|
| Rate for Payer: Cofinity Commercial |
$2,211.19
|
| Rate for Payer: Cofinity Commercial |
$2,716.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,527.07
|
| Rate for Payer: Healthscope Commercial |
$2,842.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,369.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,685.01
|
| Rate for Payer: PHP Commercial |
$2,685.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,211.19
|
| Rate for Payer: Priority Health SBD |
$1,990.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,369.13
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$1,579.42
|
|
|
Service Code
|
NDC 61874-130-11
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$694.94 |
| Max. Negotiated Rate |
$1,421.48 |
| Rate for Payer: Aetna American Axle |
$1,026.62
|
| Rate for Payer: Aetna Commercial |
$1,342.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.62
|
| Rate for Payer: Cash Price |
$1,263.54
|
| Rate for Payer: Cofinity Commercial |
$1,105.59
|
| Rate for Payer: Cofinity Commercial |
$1,358.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.54
|
| Rate for Payer: Healthscope Commercial |
$1,421.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,105.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.51
|
| Rate for Payer: PHP Commercial |
$1,342.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.59
|
| Rate for Payer: Priority Health SBD |
$995.03
|
| Rate for Payer: UMR Bronson Commercial |
$694.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.56
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$4,738.15
|
|
|
Service Code
|
NDC 61874-130-30
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,084.79 |
| Max. Negotiated Rate |
$4,264.34 |
| Rate for Payer: Aetna American Axle |
$3,079.80
|
| Rate for Payer: Aetna Commercial |
$4,027.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,079.80
|
| Rate for Payer: Cash Price |
$3,790.52
|
| Rate for Payer: Cofinity Commercial |
$3,316.70
|
| Rate for Payer: Cofinity Commercial |
$4,074.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,790.52
|
| Rate for Payer: Healthscope Commercial |
$4,264.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,316.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,553.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,027.43
|
| Rate for Payer: PHP Commercial |
$4,027.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.70
|
| Rate for Payer: Priority Health SBD |
$2,985.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,084.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.61
|
|
|
CARISOPRODOL 350 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 50228-109-01
|
| Hospital Charge Code |
1395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.18 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
CARISOPRODOL 350 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 69584-111-10
|
| Hospital Charge Code |
1395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.18 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
CARISOPRODOL 350 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 62756-446-02
|
| Hospital Charge Code |
1395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna American Axle |
$102.34
|
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.34
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.83
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.22
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UMR Bronson Commercial |
$69.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
CARISOPRODOL 350 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 61442-451-01
|
| Hospital Charge Code |
1395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna American Axle |
$114.56
|
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.81
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.38
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UMR Bronson Commercial |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.19
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$821.30
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
28911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$361.37 |
| Max. Negotiated Rate |
$739.17 |
| Rate for Payer: Aetna American Axle |
$533.84
|
| Rate for Payer: Aetna American Axle |
$7,504.81
|
| Rate for Payer: Aetna Commercial |
$698.10
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| 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 |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| Rate for Payer: Cofinity Commercial |
$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 |
$739.17
|
| Rate for Payer: Healthscope Commercial |
$10,391.27
|
| 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 Multiplan/Beech St/PHCS |
$9,813.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.10
|
| Rate for Payer: PHP Commercial |
$698.10
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,082.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.91
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| Rate for Payer: UMR Bronson Commercial |
$361.37
|
| Rate for Payer: UMR Bronson Commercial |
$5,080.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,659.40
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$821.30
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
28911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.49 |
| Max. Negotiated Rate |
$1,203.24 |
| Rate for Payer: Aetna American Axle |
$533.84
|
| Rate for Payer: Aetna American Axle |
$7,504.81
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| Rate for Payer: Aetna Commercial |
$698.10
|
| Rate for Payer: Aetna Medicare |
$282.32
|
| Rate for Payer: Aetna Medicare |
$282.32
|
| 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 |
$339.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$339.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.33
|
| Rate for Payer: BCBS Complete |
$155.93
|
| Rate for Payer: BCBS Complete |
$155.93
|
| Rate for Payer: BCBS MAPPO |
$271.46
|
| Rate for Payer: BCBS MAPPO |
$271.46
|
| Rate for Payer: BCBS Trust/PPO |
$877.23
|
| Rate for Payer: BCBS Trust/PPO |
$877.23
|
| Rate for Payer: BCN Medicare Advantage |
$271.46
|
| Rate for Payer: BCN Medicare Advantage |
$271.46
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cofinity Commercial |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$574.91
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,236.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.46
|
| Rate for Payer: Healthscope Commercial |
$739.17
|
| Rate for Payer: Healthscope Commercial |
$10,391.27
|
| 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: Mclaren Medicaid |
$148.49
|
| Rate for Payer: Mclaren Medicaid |
$148.49
|
| Rate for Payer: Mclaren Medicare |
$271.46
|
| Rate for Payer: Mclaren Medicare |
$271.46
|
| Rate for Payer: Meridian Medicaid |
$155.93
|
| Rate for Payer: Meridian Medicaid |
$155.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$285.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$285.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,813.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.10
|
| Rate for Payer: PACE Medicare |
$257.89
|
| Rate for Payer: PACE Medicare |
$257.89
|
| Rate for Payer: PACE SWMI |
$271.46
|
| Rate for Payer: PACE SWMI |
$271.46
|
| Rate for Payer: PHP Commercial |
$698.10
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: PHP Medicare Advantage |
$271.46
|
| Rate for Payer: PHP Medicare Advantage |
$271.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,082.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,203.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,203.24
|
| Rate for Payer: Priority Health Medicare |
$271.46
|
| Rate for Payer: Priority Health Medicare |
$271.46
|
| Rate for Payer: Priority Health Narrow Network |
$962.59
|
| Rate for Payer: Priority Health Narrow Network |
$962.59
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| Rate for Payer: Railroad Medicare Medicare |
$271.46
|
| Rate for Payer: Railroad Medicare Medicare |
$271.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.46
|
| Rate for Payer: UHC Medicare Advantage |
$279.61
|
| Rate for Payer: UHC Medicare Advantage |
$279.61
|
| Rate for Payer: UMR Bronson Commercial |
$4,271.97
|
| Rate for Payer: UMR Bronson Commercial |
$303.88
|
| Rate for Payer: VA VA |
$271.46
|
| Rate for Payer: VA VA |
$271.46
|
| 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
|
IP
|
$143,383.38
|
|
|
Service Code
|
NDC 24338-050-08
|
| 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: 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 Multiplan/Beech St/PHCS |
$121,875.87
|
| Rate for Payer: PHP Commercial |
$121,875.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100,368.37
|
| 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
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$42,947.97
|
|
|
Service Code
|
MS-DRG 035
|
| Min. Negotiated Rate |
$17,320.77 |
| Max. Negotiated Rate |
$42,947.97 |
| Rate for Payer: Aetna Medicare |
$18,961.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,790.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,790.49
|
| Rate for Payer: BCBS MAPPO |
$18,232.39
|
| Rate for Payer: BCBS Trust/PPO |
$42,947.97
|
| Rate for Payer: BCN Medicare Advantage |
$18,232.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,232.39
|
| Rate for Payer: Mclaren Medicare |
$18,232.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,144.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,967.25
|
| Rate for Payer: PACE Medicare |
$17,320.77
|
| Rate for Payer: PACE SWMI |
$18,232.39
|
| Rate for Payer: PHP Medicare Advantage |
$18,232.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,997.64
|
| Rate for Payer: Priority Health Medicare |
$18,232.39
|
| Rate for Payer: Priority Health Narrow Network |
$26,398.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18,232.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,076.57
|
| Rate for Payer: UHC Core |
$28,762.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,232.39
|
| Rate for Payer: UHC Exchange |
$22,866.23
|
| Rate for Payer: UHC Medicare Advantage |
$18,779.36
|
| Rate for Payer: VA VA |
$18,232.39
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$67,091.92
|
|
|
Service Code
|
MS-DRG 034
|
| Min. Negotiated Rate |
$29,047.84 |
| Max. Negotiated Rate |
$67,091.92 |
| Rate for Payer: Aetna Medicare |
$31,799.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,220.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,220.84
|
| Rate for Payer: BCBS MAPPO |
$30,576.67
|
| Rate for Payer: BCBS Trust/PPO |
$67,091.92
|
| Rate for Payer: BCN Medicare Advantage |
$30,576.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,576.67
|
| Rate for Payer: Mclaren Medicare |
$30,576.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,105.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,163.17
|
| Rate for Payer: PACE Medicare |
$29,047.84
|
| Rate for Payer: PACE SWMI |
$30,576.67
|
| Rate for Payer: PHP Medicare Advantage |
$30,576.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,984.78
|
| Rate for Payer: Priority Health Medicare |
$30,576.67
|
| Rate for Payer: Priority Health Narrow Network |
$44,787.82
|
| Rate for Payer: Railroad Medicare Medicare |
$30,576.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,511.96
|
| Rate for Payer: UHC Core |
$48,798.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,576.67
|
| Rate for Payer: UHC Exchange |
$38,795.52
|
| Rate for Payer: UHC Medicare Advantage |
$31,493.97
|
| Rate for Payer: VA VA |
$30,576.67
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,717.82
|
|
|
Service Code
|
MS-DRG 036
|
| Min. Negotiated Rate |
$13,724.09 |
| Max. Negotiated Rate |
$31,717.82 |
| Rate for Payer: Aetna Medicare |
$15,024.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,058.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,058.01
|
| Rate for Payer: BCBS MAPPO |
$14,446.41
|
| Rate for Payer: BCBS Trust/PPO |
$31,717.82
|
| Rate for Payer: BCN Medicare Advantage |
$14,446.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,446.41
|
| Rate for Payer: Mclaren Medicare |
$14,446.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,168.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,613.37
|
| Rate for Payer: PACE Medicare |
$13,724.09
|
| Rate for Payer: PACE SWMI |
$14,446.41
|
| Rate for Payer: PHP Medicare Advantage |
$14,446.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,947.53
|
| Rate for Payer: Priority Health Medicare |
$14,446.41
|
| Rate for Payer: Priority Health Narrow Network |
$20,758.02
|
| Rate for Payer: Railroad Medicare Medicare |
$14,446.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,582.28
|
| Rate for Payer: UHC Core |
$22,616.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,446.41
|
| Rate for Payer: UHC Exchange |
$17,980.74
|
| Rate for Payer: UHC Medicare Advantage |
$14,879.80
|
| Rate for Payer: VA VA |
$14,446.41
|
|
|
CARPECTOMY; 1 BONE
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$495.75 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.32
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$495.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$619.85 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.84
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$619.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.72 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.59
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$478.72
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 68462-164-01
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 51079-931-01
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| 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 Multiplan/Beech St/PHCS |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 0904-6302-61
|
| 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: 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 Multiplan/Beech St/PHCS |
$153.81
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.66
|
| 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
|
$204.45
|
|
|
Service Code
|
NDC 51079-931-20
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna American Axle |
$132.89
|
| Rate for Payer: Aetna Commercial |
$173.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.89
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$143.12
|
| Rate for Payer: Cofinity Commercial |
$175.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.78
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.12
|
| Rate for Payer: Priority Health SBD |
$128.80
|
| Rate for Payer: UMR Bronson Commercial |
$89.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.34
|
|
