Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$36,773.23

Service Code	APR-DRG 1623
Min. Negotiated Rate	$33,247.40
Max. Negotiated Rate	$36,773.23
Rate for Payer: BCBS Complete	$36,773.23
Rate for Payer: Mclaren Medicaid	$35,022.12
Rate for Payer: Meridian Medicaid	$36,773.23
Rate for Payer: PHP Medicaid	$33,247.40
Rate for Payer: Priority Health Choice Medicaid	$35,022.12
Rate for Payer: UHC Medicaid	$35,022.12
Rate for Payer: UHCCP Medicaid	$35,022.12

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$50,099.43

Service Code	APR-DRG 1624
Min. Negotiated Rate	$45,295.88
Max. Negotiated Rate	$50,099.43
Rate for Payer: BCBS Complete	$50,099.43
Rate for Payer: Mclaren Medicaid	$47,713.75
Rate for Payer: Meridian Medicaid	$50,099.43
Rate for Payer: PHP Medicaid	$45,295.88
Rate for Payer: Priority Health Choice Medicaid	$47,713.75
Rate for Payer: UHC Medicaid	$47,713.75
Rate for Payer: UHCCP Medicaid	$47,713.75

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$25,267.70

Service Code	APR-DRG 1621
Min. Negotiated Rate	$22,845.02
Max. Negotiated Rate	$25,267.70
Rate for Payer: BCBS Complete	$25,267.70
Rate for Payer: Mclaren Medicaid	$24,064.47
Rate for Payer: Meridian Medicaid	$25,267.70
Rate for Payer: PHP Medicaid	$22,845.02
Rate for Payer: Priority Health Choice Medicaid	$24,064.47
Rate for Payer: UHC Medicaid	$24,064.47
Rate for Payer: UHCCP Medicaid	$24,064.47

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$30,932.45

Service Code	APR-DRG 1622
Min. Negotiated Rate	$27,966.64
Max. Negotiated Rate	$30,932.45
Rate for Payer: BCBS Complete	$30,932.45
Rate for Payer: Mclaren Medicaid	$29,459.48
Rate for Payer: Meridian Medicaid	$30,932.45
Rate for Payer: PHP Medicaid	$27,966.64
Rate for Payer: Priority Health Choice Medicaid	$29,459.48
Rate for Payer: UHC Medicaid	$29,459.48
Rate for Payer: UHCCP Medicaid	$29,459.48

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$21,377.84

Service Code	APR-DRG 1631
Min. Negotiated Rate	$19,328.13
Max. Negotiated Rate	$21,377.84
Rate for Payer: BCBS Complete	$21,377.84
Rate for Payer: Mclaren Medicaid	$20,359.85
Rate for Payer: Meridian Medicaid	$21,377.84
Rate for Payer: PHP Medicaid	$19,328.13
Rate for Payer: Priority Health Choice Medicaid	$20,359.85
Rate for Payer: UHC Medicaid	$20,359.85
Rate for Payer: UHCCP Medicaid	$20,359.85

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$23,186.53

Service Code	APR-DRG 1632
Min. Negotiated Rate	$20,963.40
Max. Negotiated Rate	$23,186.53
Rate for Payer: BCBS Complete	$23,186.53
Rate for Payer: Mclaren Medicaid	$22,082.41
Rate for Payer: Meridian Medicaid	$23,186.53
Rate for Payer: PHP Medicaid	$20,963.40
Rate for Payer: Priority Health Choice Medicaid	$22,082.41
Rate for Payer: UHC Medicaid	$22,082.41
Rate for Payer: UHCCP Medicaid	$22,082.41

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$48,771.39

Service Code	APR-DRG 1634
Min. Negotiated Rate	$44,095.17
Max. Negotiated Rate	$48,771.39
Rate for Payer: BCBS Complete	$48,771.39
Rate for Payer: Mclaren Medicaid	$46,448.94
Rate for Payer: Meridian Medicaid	$48,771.39
Rate for Payer: PHP Medicaid	$44,095.17
Rate for Payer: Priority Health Choice Medicaid	$46,448.94
Rate for Payer: UHC Medicaid	$46,448.94
Rate for Payer: UHCCP Medicaid	$46,448.94

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$30,366.79

Service Code	APR-DRG 1633
Min. Negotiated Rate	$27,455.21
Max. Negotiated Rate	$30,366.79
Rate for Payer: BCBS Complete	$30,366.79
Rate for Payer: Mclaren Medicaid	$28,920.76
Rate for Payer: Meridian Medicaid	$30,366.79
Rate for Payer: PHP Medicaid	$27,455.21
Rate for Payer: Priority Health Choice Medicaid	$28,920.76
Rate for Payer: UHC Medicaid	$28,920.76
Rate for Payer: UHCCP Medicaid	$28,920.76

CARDIOMYOPATHY

Facility

$5,844.59

Service Code	APR-DRG 2053
Min. Negotiated Rate	$5,284.21
Max. Negotiated Rate	$5,844.59
Rate for Payer: BCBS Complete	$5,844.59
Rate for Payer: Mclaren Medicaid	$5,566.27
Rate for Payer: Meridian Medicaid	$5,844.59
Rate for Payer: PHP Medicaid	$5,284.21
Rate for Payer: Priority Health Choice Medicaid	$5,566.27
Rate for Payer: UHC Medicaid	$5,566.27
Rate for Payer: UHCCP Medicaid	$5,566.27

CARDIOMYOPATHY

Facility

$12,024.87

Service Code	APR-DRG 2054
Min. Negotiated Rate	$10,871.92
Max. Negotiated Rate	$12,024.87
Rate for Payer: BCBS Complete	$12,024.87
Rate for Payer: Mclaren Medicaid	$11,452.25
Rate for Payer: Meridian Medicaid	$12,024.87
Rate for Payer: PHP Medicaid	$10,871.92
Rate for Payer: Priority Health Choice Medicaid	$11,452.25
Rate for Payer: UHC Medicaid	$11,452.25
Rate for Payer: UHCCP Medicaid	$11,452.25

CARDIOMYOPATHY

Facility

$4,300.75

Service Code	APR-DRG 2052
Min. Negotiated Rate	$3,888.39
Max. Negotiated Rate	$4,300.75
Rate for Payer: BCBS Complete	$4,300.75
Rate for Payer: Mclaren Medicaid	$4,095.95
Rate for Payer: Meridian Medicaid	$4,300.75
Rate for Payer: PHP Medicaid	$3,888.39
Rate for Payer: Priority Health Choice Medicaid	$4,095.95
Rate for Payer: UHC Medicaid	$4,095.95
Rate for Payer: UHCCP Medicaid	$4,095.95

CARDIOMYOPATHY

Facility

$3,348.17

Service Code	APR-DRG 2051
Min. Negotiated Rate	$3,027.15
Max. Negotiated Rate	$3,348.17
Rate for Payer: BCBS Complete	$3,348.17
Rate for Payer: Mclaren Medicaid	$3,188.74
Rate for Payer: Meridian Medicaid	$3,348.17
Rate for Payer: PHP Medicaid	$3,027.15
Rate for Payer: Priority Health Choice Medicaid	$3,188.74
Rate for Payer: UHC Medicaid	$3,188.74
Rate for Payer: UHCCP Medicaid	$3,188.74

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$32,842.60

Service Code	MSDRG 035
Min. Negotiated Rate	$18,020.59
Max. Negotiated Rate	$32,842.60
Rate for Payer: Aetna Medicare	$18,969.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$23,711.30
Rate for Payer: Amish Plain Church Group Commercial	$23,711.30
Rate for Payer: BCBS MAPPO	$18,969.04
Rate for Payer: BCN Medicare Advantage	$18,969.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,969.04
Rate for Payer: Humana Choice PPO Medicare	$18,969.04
Rate for Payer: Mclaren Medicare	$18,969.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,917.49
Rate for Payer: MI Amish Medical Board Commercial	$21,814.40
Rate for Payer: Molina Medicare/Medicaid	$20,865.94
Rate for Payer: PACE Medicare	$18,020.59
Rate for Payer: PACE SWMI	$18,969.04
Rate for Payer: PHP Commercial	$20,865.94
Rate for Payer: PHP Medicare Advantage	$18,969.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$32,842.60
Rate for Payer: Priority Health Medicare	$18,969.04
Rate for Payer: Priority Health Narrow Network	$26,274.08
Rate for Payer: Railroad Medicare Medicare	$18,969.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,969.04
Rate for Payer: UHC Exchange	$29,402.01
Rate for Payer: UHCCP DNSP	$18,969.04
Rate for Payer: VA VA	$18,969.04

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$53,178.77

Service Code	MSDRG 034
Min. Negotiated Rate	$28,146.89
Max. Negotiated Rate	$53,178.77
Rate for Payer: Aetna Medicare	$29,628.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$37,035.39
Rate for Payer: Amish Plain Church Group Commercial	$37,035.39
Rate for Payer: BCBS MAPPO	$29,628.31
Rate for Payer: BCN Medicare Advantage	$29,628.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$29,628.31
Rate for Payer: Humana Choice PPO Medicare	$29,628.31
Rate for Payer: Mclaren Medicare	$29,628.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$31,109.73
Rate for Payer: MI Amish Medical Board Commercial	$34,072.56
Rate for Payer: Molina Medicare/Medicaid	$32,591.14
Rate for Payer: PACE Medicare	$28,146.89
Rate for Payer: PACE SWMI	$29,628.31
Rate for Payer: PHP Commercial	$32,591.14
Rate for Payer: PHP Medicare Advantage	$29,628.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$53,178.77
Rate for Payer: Priority Health Medicare	$29,628.31
Rate for Payer: Priority Health Narrow Network	$42,543.02
Rate for Payer: Railroad Medicare Medicare	$29,628.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$29,628.31
Rate for Payer: UHC Exchange	$45,923.88
Rate for Payer: UHCCP DNSP	$29,628.31
Rate for Payer: VA VA	$29,628.31

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$26,691.74

Service Code	MSDRG 036
Min. Negotiated Rate	$14,957.79
Max. Negotiated Rate	$26,691.74
Rate for Payer: Aetna Medicare	$15,745.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,681.30
Rate for Payer: Amish Plain Church Group Commercial	$19,681.30
Rate for Payer: BCBS MAPPO	$15,745.04
Rate for Payer: BCN Medicare Advantage	$15,745.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,745.04
Rate for Payer: Humana Choice PPO Medicare	$15,745.04
Rate for Payer: Mclaren Medicare	$15,745.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,532.29
Rate for Payer: MI Amish Medical Board Commercial	$18,106.80
Rate for Payer: Molina Medicare/Medicaid	$17,319.54
Rate for Payer: PACE Medicare	$14,957.79
Rate for Payer: PACE SWMI	$15,745.04
Rate for Payer: PHP Commercial	$17,319.54
Rate for Payer: PHP Medicare Advantage	$15,745.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$26,691.74
Rate for Payer: Priority Health Medicare	$15,745.04
Rate for Payer: Priority Health Narrow Network	$21,353.39
Rate for Payer: Railroad Medicare Medicare	$15,745.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,745.04
Rate for Payer: UHC Exchange	$24,404.81
Rate for Payer: UHCCP DNSP	$15,745.04
Rate for Payer: VA VA	$15,745.04

CARVEDILOL 3.125 MG TABLET

Facility

$1.86

Service Code	NDC 51079077101
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.67
Rate for Payer: Aetna Medicare	$0.69
Rate for Payer: ASR ASR	$1.80
Rate for Payer: BCBS Complete	$0.74
Rate for Payer: BCBS Trust/PPO	$1.53
Rate for Payer: BCN Commercial	$1.53
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cofinity Commercial	$1.75
Rate for Payer: Encore Health Key Benefits Commercial	$1.49
Rate for Payer: Healthscope Commercial	$1.80
Rate for Payer: Healthscope Whirlpool	$1.86
Rate for Payer: Mclaren Commercial	$1.67
Rate for Payer: MI Amish Medical Board Commercial	$1.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.58
Rate for Payer: Nomi Health Commercial	$1.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.63
Rate for Payer: Priority Health Narrow Network	$1.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.63

CARVEDILOL 3.125 MG TABLET

Facility

$246.75

Service Code	NDC 68084084301
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$91.30
Max. Negotiated Rate	$246.75
Rate for Payer: Aetna Commercial	$222.07
Rate for Payer: Aetna Medicare	$91.30
Rate for Payer: ASR ASR	$239.35
Rate for Payer: BCBS Complete	$98.70
Rate for Payer: BCBS Trust/PPO	$203.45
Rate for Payer: BCN Commercial	$203.45
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Commercial	$231.94
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$239.35
Rate for Payer: Healthscope Whirlpool	$246.75
Rate for Payer: Mclaren Commercial	$222.07
Rate for Payer: MI Amish Medical Board Commercial	$197.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Nomi Health Commercial	$202.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$216.20
Rate for Payer: Priority Health Narrow Network	$172.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$217.14

CARVEDILOL 3.125 MG TABLET

Facility

$246.75

Service Code	NDC 68084084301
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$185.06
Max. Negotiated Rate	$246.75
Rate for Payer: Aetna Commercial	$222.07
Rate for Payer: ASR ASR	$239.35
Rate for Payer: BCBS Trust/PPO	$202.63
Rate for Payer: BCN Commercial	$202.63
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Commercial	$231.94
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$239.35
Rate for Payer: Healthscope Whirlpool	$246.75
Rate for Payer: Mclaren Commercial	$222.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Nomi Health Commercial	$202.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$217.14

CARVEDILOL 3.125 MG TABLET

Facility

$63.45

Service Code	NDC 68382009201
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$63.45
Rate for Payer: Aetna Commercial	$57.10
Rate for Payer: ASR ASR	$61.55
Rate for Payer: BCBS Trust/PPO	$52.11
Rate for Payer: BCN Commercial	$52.11
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$59.64
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$61.55
Rate for Payer: Healthscope Whirlpool	$63.45
Rate for Payer: Mclaren Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: Nomi Health Commercial	$52.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.84

CARVEDILOL 3.125 MG TABLET

Facility

$180.95

Service Code	NDC 904630061
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$66.95
Max. Negotiated Rate	$180.95
Rate for Payer: Aetna Commercial	$162.85
Rate for Payer: Aetna Medicare	$66.95
Rate for Payer: ASR ASR	$175.52
Rate for Payer: BCBS Complete	$72.38
Rate for Payer: BCBS Trust/PPO	$149.19
Rate for Payer: BCN Commercial	$149.19
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$170.09
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$175.52
Rate for Payer: Healthscope Whirlpool	$180.95
Rate for Payer: Mclaren Commercial	$162.85
Rate for Payer: MI Amish Medical Board Commercial	$144.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: Nomi Health Commercial	$148.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$158.55
Rate for Payer: Priority Health Narrow Network	$126.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$159.24

CARVEDILOL 3.125 MG TABLET

Facility

$63.45

Service Code	NDC 68382009201
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$23.48
Max. Negotiated Rate	$63.45
Rate for Payer: Aetna Commercial	$57.10
Rate for Payer: Aetna Medicare	$23.48
Rate for Payer: ASR ASR	$61.55
Rate for Payer: BCBS Complete	$25.38
Rate for Payer: BCBS Trust/PPO	$52.31
Rate for Payer: BCN Commercial	$52.31
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$59.64
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$61.55
Rate for Payer: Healthscope Whirlpool	$63.45
Rate for Payer: Mclaren Commercial	$57.10
Rate for Payer: MI Amish Medical Board Commercial	$50.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: Nomi Health Commercial	$52.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$55.59
Rate for Payer: Priority Health Narrow Network	$44.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.84

CARVEDILOL 3.125 MG TABLET

Facility

$2.47

Service Code	NDC 68084084311
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: ASR ASR	$2.39
Rate for Payer: BCBS Trust/PPO	$2.03
Rate for Payer: BCN Commercial	$2.03
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.97
Rate for Payer: Healthscope Commercial	$2.39
Rate for Payer: Healthscope Whirlpool	$2.47
Rate for Payer: Mclaren Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Nomi Health Commercial	$2.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.17

CARVEDILOL 3.125 MG TABLET

Facility

$180.95

Service Code	NDC 904630061
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$135.71
Max. Negotiated Rate	$180.95
Rate for Payer: Aetna Commercial	$162.85
Rate for Payer: ASR ASR	$175.52
Rate for Payer: BCBS Trust/PPO	$148.60
Rate for Payer: BCN Commercial	$148.60
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$170.09
Rate for Payer: Encore Health Key Benefits Commercial	$144.76
Rate for Payer: Healthscope Commercial	$175.52
Rate for Payer: Healthscope Whirlpool	$180.95
Rate for Payer: Mclaren Commercial	$162.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.81
Rate for Payer: Nomi Health Commercial	$148.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$159.24

CARVEDILOL 3.125 MG TABLET

Facility

$1.86

Service Code	NDC 51079077101
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.67
Rate for Payer: ASR ASR	$1.80
Rate for Payer: BCBS Trust/PPO	$1.52
Rate for Payer: BCN Commercial	$1.52
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cofinity Commercial	$1.75
Rate for Payer: Encore Health Key Benefits Commercial	$1.49
Rate for Payer: Healthscope Commercial	$1.80
Rate for Payer: Healthscope Whirlpool	$1.86
Rate for Payer: Mclaren Commercial	$1.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.58
Rate for Payer: Nomi Health Commercial	$1.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.63

CARVEDILOL 3.125 MG TABLET

Facility

$2.47

Service Code	NDC 68084084311
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare	$0.91
Rate for Payer: ASR ASR	$2.39
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: BCBS Trust/PPO	$2.03
Rate for Payer: BCN Commercial	$2.03
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$1.97
Rate for Payer: Healthscope Commercial	$2.39
Rate for Payer: Healthscope Whirlpool	$2.47
Rate for Payer: Mclaren Commercial	$2.22
Rate for Payer: MI Amish Medical Board Commercial	$1.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: Nomi Health Commercial	$2.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.16
Rate for Payer: Priority Health Narrow Network	$1.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.17

Know your out-of-pocket cost for care.

All Charges