|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
IP
|
$5,485.07
|
|
|
Service Code
|
NDC 61874013030
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,413.43 |
| Max. Negotiated Rate |
$4,936.56 |
| Rate for Payer: Aetna American Axle |
$3,565.30
|
| Rate for Payer: Aetna Commercial |
$4,662.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,565.30
|
| Rate for Payer: Cash Price |
$4,388.06
|
| Rate for Payer: Cofinity Advantage |
$3,839.55
|
| Rate for Payer: Cofinity Commercial |
$4,717.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,388.06
|
| Rate for Payer: Healthscope Commercial |
$4,936.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,839.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,113.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,662.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,113.80
|
| Rate for Payer: PHP Commercial |
$4,662.31
|
| Rate for Payer: Priority Health SBD |
$3,455.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,413.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,113.80
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$3,656.71
|
|
|
Service Code
|
NDC 61874013020
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,352.98 |
| Max. Negotiated Rate |
$3,291.04 |
| Rate for Payer: Aetna American Axle |
$2,376.86
|
| Rate for Payer: Aetna Commercial |
$3,108.20
|
| Rate for Payer: Aetna Medicare |
$1,828.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.86
|
| Rate for Payer: BCBS Complete |
$1,462.68
|
| Rate for Payer: Cash Price |
$2,925.37
|
| Rate for Payer: Cofinity Advantage |
$2,559.70
|
| Rate for Payer: Cofinity Commercial |
$3,144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,925.37
|
| Rate for Payer: Healthscope Commercial |
$3,291.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,559.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,742.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,925.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,108.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,742.53
|
| Rate for Payer: PHP Commercial |
$3,108.20
|
| Rate for Payer: Priority Health SBD |
$2,303.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,376.86
|
| Rate for Payer: UHC Core |
$1,905.15
|
| Rate for Payer: UHC Exchange |
$1,437.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,352.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,742.53
|
|
|
CARIPRAZINE 3 MG CAPSULE
|
Facility
|
OP
|
$1,828.36
|
|
|
Service Code
|
NDC 61874013011
|
| Hospital Charge Code |
177103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.49 |
| Max. Negotiated Rate |
$1,645.52 |
| Rate for Payer: Aetna American Axle |
$1,188.43
|
| Rate for Payer: Aetna Commercial |
$1,554.11
|
| Rate for Payer: Aetna Medicare |
$914.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.43
|
| Rate for Payer: BCBS Complete |
$731.34
|
| Rate for Payer: Cash Price |
$1,462.69
|
| Rate for Payer: Cofinity Advantage |
$1,279.85
|
| Rate for Payer: Cofinity Commercial |
$1,572.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.69
|
| Rate for Payer: Healthscope Commercial |
$1,645.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.27
|
| Rate for Payer: PHP Commercial |
$1,554.11
|
| Rate for Payer: Priority Health SBD |
$1,151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.43
|
| Rate for Payer: UHC Core |
$952.58
|
| Rate for Payer: UHC Exchange |
$718.55
|
| Rate for Payer: UMR Bronson Commercial |
$676.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.27
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$821.30
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
28911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.46 |
| Max. Negotiated Rate |
$754.31 |
| Rate for Payer: Aetna American Axle |
$533.85
|
| Rate for Payer: Aetna American Axle |
$7,504.81
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| Rate for Payer: Aetna Commercial |
$698.11
|
| Rate for Payer: Aetna Medicare |
$251.47
|
| Rate for Payer: Aetna Medicare |
$251.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,504.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.25
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$241.80
|
| Rate for Payer: BCBS MAPPO |
$241.80
|
| Rate for Payer: BCBS Trust/PPO |
$754.31
|
| Rate for Payer: BCBS Trust/PPO |
$754.31
|
| Rate for Payer: BCN Commercial |
$754.31
|
| Rate for Payer: BCN Commercial |
$754.31
|
| Rate for Payer: BCN Medicare Advantage |
$241.80
|
| Rate for Payer: BCN Medicare Advantage |
$241.80
|
| Rate for Payer: Cash Price |
$9,236.69
|
| 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: Cofinity Advantage |
$574.91
|
| Rate for Payer: Cofinity Advantage |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| 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 |
$241.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.80
|
| 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 |
$241.80
|
| Rate for Payer: Mclaren Medicaid |
$241.80
|
| Rate for Payer: Mclaren Medicare |
$241.80
|
| Rate for Payer: Mclaren Medicare |
$241.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.89
|
| Rate for Payer: Meridian Medicaid |
$253.89
|
| Rate for Payer: Meridian Medicaid |
$253.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,813.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.11
|
| Rate for Payer: Nomi Health Commercial |
$725.40
|
| Rate for Payer: Nomi Health Commercial |
$725.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,659.40
|
| Rate for Payer: PACE Medicare |
$229.71
|
| Rate for Payer: PACE Medicare |
$229.71
|
| Rate for Payer: PACE SWMI |
$241.80
|
| Rate for Payer: PACE SWMI |
$241.80
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: PHP Commercial |
$698.11
|
| Rate for Payer: PHP Medicare Advantage |
$241.80
|
| Rate for Payer: PHP Medicare Advantage |
$241.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$752.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$752.08
|
| Rate for Payer: Priority Health Medicare |
$241.80
|
| Rate for Payer: Priority Health Medicare |
$241.80
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: Priority Health Tiered Network |
$601.66
|
| Rate for Payer: Priority Health Tiered Network |
$601.66
|
| Rate for Payer: Railroad Medicare Medicare |
$241.80
|
| Rate for Payer: Railroad Medicare Medicare |
$241.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.82
|
| Rate for Payer: UHC Core |
$383.82
|
| Rate for Payer: UHC Core |
$383.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$241.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$241.80
|
| Rate for Payer: UHC Exchange |
$383.82
|
| Rate for Payer: UHC Exchange |
$383.82
|
| Rate for Payer: UHC Medicaid |
$126.46
|
| Rate for Payer: UHC Medicaid |
$126.46
|
| Rate for Payer: UHCCP Medicaid |
$126.46
|
| Rate for Payer: UHCCP Medicaid |
$126.46
|
| Rate for Payer: UMR Bronson Commercial |
$4,271.97
|
| Rate for Payer: UMR Bronson Commercial |
$303.88
|
| Rate for Payer: VA VA |
$241.80
|
| Rate for Payer: VA VA |
$241.80
|
| 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
|
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 |
$533.85
|
| Rate for Payer: Aetna Commercial |
$9,813.98
|
| Rate for Payer: Aetna Commercial |
$698.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,504.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.85
|
| Rate for Payer: Cash Price |
$9,236.69
|
| Rate for Payer: Cash Price |
$657.04
|
| Rate for Payer: Cofinity Advantage |
$574.91
|
| Rate for Payer: Cofinity Advantage |
$8,082.10
|
| Rate for Payer: Cofinity Commercial |
$706.32
|
| Rate for Payer: Cofinity Commercial |
$9,929.44
|
| 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 |
$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: Multiplan/Beech St/PHCS Commercial |
$9,813.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,659.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.98
|
| Rate for Payer: PHP Commercial |
$9,813.98
|
| Rate for Payer: PHP Commercial |
$698.11
|
| Rate for Payer: Priority Health SBD |
$517.42
|
| Rate for Payer: Priority Health SBD |
$7,273.89
|
| 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 IN POLIFEPROSAN 7.7 MG WAFER FOR IMPLANT
|
Facility
|
OP
|
$156,287.86
|
|
|
Service Code
|
NDC 24338005008
|
| Hospital Charge Code |
21672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57,826.51 |
| Max. Negotiated Rate |
$140,659.07 |
| Rate for Payer: Aetna American Axle |
$101,587.11
|
| Rate for Payer: Aetna Commercial |
$132,844.68
|
| Rate for Payer: Aetna Medicare |
$78,143.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101,587.11
|
| Rate for Payer: BCBS Complete |
$62,515.14
|
| Rate for Payer: Cash Price |
$125,030.29
|
| Rate for Payer: Cofinity Advantage |
$109,401.50
|
| Rate for Payer: Cofinity Commercial |
$134,407.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125,030.29
|
| Rate for Payer: Healthscope Commercial |
$140,659.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109,401.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117,215.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125,030.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132,844.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117,215.90
|
| Rate for Payer: PHP Commercial |
$132,844.68
|
| Rate for Payer: Priority Health SBD |
$98,461.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101,587.11
|
| Rate for Payer: UHC Core |
$81,425.98
|
| Rate for Payer: UHC Exchange |
$61,421.13
|
| Rate for Payer: UMR Bronson Commercial |
$57,826.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117,215.90
|
|
|
CARMUSTINE IN POLIFEPROSAN 7.7 MG WAFER FOR IMPLANT
|
Facility
|
IP
|
$156,287.86
|
|
|
Service Code
|
NDC 24338005008
|
| Hospital Charge Code |
21672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68,766.66 |
| Max. Negotiated Rate |
$140,659.07 |
| Rate for Payer: Aetna American Axle |
$101,587.11
|
| Rate for Payer: Aetna Commercial |
$132,844.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101,587.11
|
| Rate for Payer: Cash Price |
$125,030.29
|
| Rate for Payer: Cofinity Advantage |
$109,401.50
|
| Rate for Payer: Cofinity Commercial |
$134,407.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125,030.29
|
| Rate for Payer: Healthscope Commercial |
$140,659.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109,401.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117,215.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132,844.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117,215.90
|
| Rate for Payer: PHP Commercial |
$132,844.68
|
| Rate for Payer: Priority Health SBD |
$98,461.35
|
| Rate for Payer: UMR Bronson Commercial |
$68,766.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117,215.90
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$46,916.50
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$19,554.79 |
| Max. Negotiated Rate |
$46,916.50 |
| Rate for Payer: Aetna Medicare |
$21,407.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,729.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,729.99
|
| Rate for Payer: BCBS MAPPO |
$20,583.99
|
| Rate for Payer: BCBS Trust/PPO |
$46,916.50
|
| Rate for Payer: BCN Commercial |
$46,916.50
|
| Rate for Payer: BCN Medicare Advantage |
$20,583.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,583.99
|
| Rate for Payer: Mclaren Medicare |
$20,583.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,613.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,671.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,642.39
|
| Rate for Payer: Nomi Health Commercial |
$30,837.45
|
| Rate for Payer: PACE Medicare |
$19,554.79
|
| Rate for Payer: PACE SWMI |
$20,583.99
|
| Rate for Payer: PHP Medicare Advantage |
$20,583.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,539.98
|
| Rate for Payer: Priority Health Medicare |
$20,583.99
|
| Rate for Payer: Priority Health Tiered Network |
$30,831.98
|
| Rate for Payer: Railroad Medicare Medicare |
$20,583.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,965.15
|
| Rate for Payer: UHC Core |
$32,599.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,583.99
|
| Rate for Payer: UHC Exchange |
$26,623.00
|
| Rate for Payer: VA VA |
$20,583.99
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,291.42
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$31,314.32 |
| Max. Negotiated Rate |
$73,291.42 |
| Rate for Payer: Aetna Medicare |
$34,280.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,203.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,203.05
|
| Rate for Payer: BCBS MAPPO |
$32,962.44
|
| Rate for Payer: BCBS Trust/PPO |
$73,291.42
|
| Rate for Payer: BCN Commercial |
$73,291.42
|
| Rate for Payer: BCN Medicare Advantage |
$32,962.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,962.44
|
| Rate for Payer: Mclaren Medicare |
$32,962.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,610.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,906.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,258.68
|
| Rate for Payer: Nomi Health Commercial |
$49,932.03
|
| Rate for Payer: PACE Medicare |
$31,314.32
|
| Rate for Payer: PACE SWMI |
$32,962.44
|
| Rate for Payer: PHP Medicare Advantage |
$32,962.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,403.97
|
| Rate for Payer: Priority Health Medicare |
$32,962.44
|
| Rate for Payer: Priority Health Tiered Network |
$49,923.17
|
| Rate for Payer: Railroad Medicare Medicare |
$32,962.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63,092.41
|
| Rate for Payer: UHC Core |
$52,784.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,962.44
|
| Rate for Payer: UHC Exchange |
$43,107.99
|
| Rate for Payer: VA VA |
$32,962.44
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,648.65
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$15,998.01 |
| Max. Negotiated Rate |
$34,648.65 |
| Rate for Payer: Aetna Medicare |
$17,513.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,050.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,050.01
|
| Rate for Payer: BCBS MAPPO |
$16,840.01
|
| Rate for Payer: BCBS Trust/PPO |
$34,648.65
|
| Rate for Payer: BCN Commercial |
$34,648.65
|
| Rate for Payer: BCN Medicare Advantage |
$16,840.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,840.01
|
| Rate for Payer: Mclaren Medicare |
$16,840.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,682.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,366.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,524.01
|
| Rate for Payer: Nomi Health Commercial |
$25,062.12
|
| Rate for Payer: PACE Medicare |
$15,998.01
|
| Rate for Payer: PACE SWMI |
$16,840.01
|
| Rate for Payer: PHP Medicare Advantage |
$16,840.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,322.09
|
| Rate for Payer: Priority Health Medicare |
$16,840.01
|
| Rate for Payer: Priority Health Tiered Network |
$25,057.67
|
| Rate for Payer: Railroad Medicare Medicare |
$16,840.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,667.64
|
| Rate for Payer: UHC Core |
$26,493.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,840.01
|
| Rate for Payer: UHC Exchange |
$21,636.96
|
| Rate for Payer: VA VA |
$16,840.01
|
|
|
CARPECTOMY; 1 BONE
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,866.80
|
| Rate for Payer: BCN Commercial |
$2,866.80
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,546.78
|
| Rate for Payer: BCN Commercial |
$2,546.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 68462016401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.85 |
| 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 Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| 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
|
$2.05
|
|
|
Service Code
|
NDC 51079093101
|
| 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 Advantage |
$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 Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.54
|
| Rate for Payer: PHP Commercial |
$1.74
|
| 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
|
$72.85
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$204.45
|
|
|
Service Code
|
NDC 51079093120
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna American Axle |
$132.89
|
| Rate for Payer: Aetna Commercial |
$173.78
|
| Rate for Payer: Aetna Medicare |
$102.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.89
|
| Rate for Payer: BCBS Complete |
$81.78
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$163.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: PHP Commercial |
$173.78
|
| Rate for Payer: Priority Health SBD |
$128.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.89
|
| Rate for Payer: UHC Core |
$106.52
|
| Rate for Payer: UHC Exchange |
$80.35
|
| Rate for Payer: UMR Bronson Commercial |
$75.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.34
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$162.85 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.81
|
| Rate for Payer: Aetna Medicare |
$90.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: BCBS Complete |
$72.38
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cofinity Advantage |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.76
|
| Rate for Payer: Healthscope Commercial |
$162.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.71
|
| Rate for Payer: PHP Commercial |
$153.81
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.62
|
| Rate for Payer: UHC Core |
$94.27
|
| Rate for Payer: UHC Exchange |
$71.11
|
| Rate for Payer: UMR Bronson Commercial |
$66.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.71
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 00904730761
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.81
|
| Rate for Payer: UHC Core |
$124.88
|
| Rate for Payer: UHC Exchange |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$88.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
IP
|
$204.45
|
|
|
Service Code
|
NDC 51079093120
|
| 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 Advantage |
$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 Commercial |
$173.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: PHP Commercial |
$173.78
|
| 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
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.35
|
| Rate for Payer: UHC Core |
$37.95
|
| Rate for Payer: UHC Exchange |
$28.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
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 Advantage |
$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: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.54
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.33
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Exchange |
$0.81
|
| 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
|
$239.70
|
|
|
Service Code
|
NDC 00904730761
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$105.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
CARVEDILOL 12.5 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 68462016401
|
| Hospital Charge Code |
15749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
