|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 68084009311
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: ASR ASR |
$1.96
|
| Rate for Payer: ASR Commercial |
$1.96
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Healthscope Whirlpool |
$1.96
|
| Rate for Payer: Mclaren Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.77
|
| Rate for Payer: Priority Health Narrow Network |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.78
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS Trust/PPO |
$269.42
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.27
|
| Rate for Payer: Priority Health Narrow Network |
$230.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 00904623761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: ASR ASR |
$319.13
|
| Rate for Payer: ASR Commercial |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$268.10
|
| Rate for Payer: BCN Commercial |
$255.07
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$329.00
|
| Rate for Payer: Healthscope Whirlpool |
$319.13
|
| Rate for Payer: Mclaren Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.52
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 00904725761
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.71 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: ASR ASR |
$348.76
|
| Rate for Payer: ASR Commercial |
$348.76
|
| Rate for Payer: BCBS Trust/PPO |
$293.00
|
| Rate for Payer: BCN Commercial |
$278.76
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$337.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Healthscope Whirlpool |
$348.76
|
| Rate for Payer: Mclaren Commercial |
$323.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Nomi Health Commercial |
$294.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.40
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 68084009301
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.53 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$182.12
|
| Rate for Payer: ASR ASR |
$196.28
|
| Rate for Payer: ASR Commercial |
$196.28
|
| Rate for Payer: BCBS Trust/PPO |
$164.90
|
| Rate for Payer: BCN Commercial |
$156.88
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Commercial |
$190.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$202.35
|
| Rate for Payer: Healthscope Whirlpool |
$196.28
|
| Rate for Payer: Mclaren Commercial |
$182.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.00
|
| Rate for Payer: Nomi Health Commercial |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.07
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 68084009411
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.93
|
| Rate for Payer: Priority Health Narrow Network |
$167.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS Trust/PPO |
$164.15
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.63
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 00904623861
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Trust/PPO |
$163.35
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084009401
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$194.31
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 68084009411
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$194.31
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 68084009401
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: ASR Commercial |
$231.30
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.93
|
| Rate for Payer: Priority Health Narrow Network |
$167.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$2.95
|
| Rate for Payer: ASR ASR |
$3.18
|
| Rate for Payer: ASR Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Healthscope Whirlpool |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.79
|
| Rate for Payer: Nomi Health Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.89
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 68084028111
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$2.95
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: ASR ASR |
$3.18
|
| Rate for Payer: ASR Commercial |
$3.18
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.54
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Healthscope Whirlpool |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.79
|
| Rate for Payer: Nomi Health Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.87
|
| Rate for Payer: Priority Health Narrow Network |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.89
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$445.70
|
|
|
Service Code
|
NDC 00009085605
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$445.70 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Medicare |
$222.85
|
| Rate for Payer: ASR ASR |
$432.33
|
| Rate for Payer: ASR Commercial |
$432.33
|
| Rate for Payer: BCBS Complete |
$178.28
|
| Rate for Payer: BCBS Trust/PPO |
$364.98
|
| Rate for Payer: BCN Commercial |
$345.55
|
| Rate for Payer: Cash Price |
$356.56
|
| Rate for Payer: Cofinity Commercial |
$418.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.56
|
| Rate for Payer: Healthscope Commercial |
$445.70
|
| Rate for Payer: Healthscope Whirlpool |
$432.33
|
| Rate for Payer: Mclaren Commercial |
$401.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.84
|
| Rate for Payer: Nomi Health Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.52
|
| Rate for Payer: Priority Health Narrow Network |
$312.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.22
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$445.70
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$445.70 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Medicare |
$222.85
|
| Rate for Payer: ASR ASR |
$432.33
|
| Rate for Payer: ASR Commercial |
$432.33
|
| Rate for Payer: BCBS Complete |
$178.28
|
| Rate for Payer: BCBS Trust/PPO |
$364.98
|
| Rate for Payer: BCN Commercial |
$345.55
|
| Rate for Payer: Cash Price |
$356.56
|
| Rate for Payer: Cofinity Commercial |
$418.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.56
|
| Rate for Payer: Healthscope Commercial |
$445.70
|
| Rate for Payer: Healthscope Whirlpool |
$432.33
|
| Rate for Payer: Mclaren Commercial |
$401.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.84
|
| Rate for Payer: Nomi Health Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.52
|
| Rate for Payer: Priority Health Narrow Network |
$312.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.22
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$445.70
|
|
|
Service Code
|
NDC 00009085608
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$445.70 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: ASR ASR |
$432.33
|
| Rate for Payer: ASR Commercial |
$432.33
|
| Rate for Payer: BCBS Trust/PPO |
$363.20
|
| Rate for Payer: BCN Commercial |
$345.55
|
| Rate for Payer: Cash Price |
$356.56
|
| Rate for Payer: Cofinity Commercial |
$418.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.56
|
| Rate for Payer: Healthscope Commercial |
$445.70
|
| Rate for Payer: Healthscope Whirlpool |
$432.33
|
| Rate for Payer: Mclaren Commercial |
$401.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.84
|
| Rate for Payer: Nomi Health Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.22
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$445.70
|
|
|
Service Code
|
NDC 00009085605
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$445.70 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: ASR ASR |
$432.33
|
| Rate for Payer: ASR Commercial |
$432.33
|
| Rate for Payer: BCBS Trust/PPO |
$363.20
|
| Rate for Payer: BCN Commercial |
$345.55
|
| Rate for Payer: Cash Price |
$356.56
|
| Rate for Payer: Cofinity Commercial |
$418.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.56
|
| Rate for Payer: Healthscope Commercial |
$445.70
|
| Rate for Payer: Healthscope Whirlpool |
$432.33
|
| Rate for Payer: Mclaren Commercial |
$401.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.84
|
| Rate for Payer: Nomi Health Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.22
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$28.25 |
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: ASR ASR |
$27.40
|
| Rate for Payer: ASR Commercial |
$27.40
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: BCBS Trust/PPO |
$23.13
|
| Rate for Payer: BCN Commercial |
$21.90
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$26.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$28.25
|
| Rate for Payer: Healthscope Whirlpool |
$27.40
|
| Rate for Payer: Mclaren Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.75
|
| Rate for Payer: Priority Health Narrow Network |
$19.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.86
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 00023920515
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$28.25 |
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: ASR ASR |
$27.40
|
| Rate for Payer: ASR Commercial |
$27.40
|
| Rate for Payer: BCBS Trust/PPO |
$23.02
|
| Rate for Payer: BCN Commercial |
$21.90
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$26.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$28.25
|
| Rate for Payer: Healthscope Whirlpool |
$27.40
|
| Rate for Payer: Mclaren Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.86
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 68084084301
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$201.08
|
| Rate for Payer: BCN Commercial |
$191.31
|
| 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 |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.14
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 68084084311
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: ASR ASR |
$2.40
|
| Rate for Payer: ASR Commercial |
$2.40
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Healthscope Whirlpool |
$2.40
|
| Rate for Payer: Mclaren Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: 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
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079077101
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: ASR Commercial |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.52
|
| Rate for Payer: BCN Commercial |
$1.44
|
| 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 |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$180.95 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: ASR ASR |
$175.52
|
| Rate for Payer: ASR Commercial |
$175.52
|
| Rate for Payer: BCBS Trust/PPO |
$147.46
|
| Rate for Payer: BCN Commercial |
$140.29
|
| 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 |
$180.95
|
| Rate for Payer: Healthscope Whirlpool |
$175.52
|
| Rate for Payer: Mclaren Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.24
|
|
|
CARVEDILOL 3.125 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 68084084301
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: ASR ASR |
$239.35
|
| Rate for Payer: ASR Commercial |
$239.35
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: BCBS Trust/PPO |
$202.06
|
| Rate for Payer: BCN Commercial |
$191.31
|
| 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 |
$246.75
|
| Rate for Payer: Healthscope Whirlpool |
$239.35
|
| Rate for Payer: Mclaren Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: Nomi Health Commercial |
$202.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: 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
|
OP
|
$180.95
|
|
|
Service Code
|
NDC 00904630061
|
| Hospital Charge Code |
18551
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$180.95 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Medicare |
$90.48
|
| Rate for Payer: ASR ASR |
$175.52
|
| Rate for Payer: ASR Commercial |
$175.52
|
| Rate for Payer: BCBS Complete |
$72.38
|
| Rate for Payer: BCBS Trust/PPO |
$148.18
|
| Rate for Payer: BCN Commercial |
$140.29
|
| 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 |
$180.95
|
| Rate for Payer: Healthscope Whirlpool |
$175.52
|
| Rate for Payer: Mclaren Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.81
|
| Rate for Payer: Nomi Health Commercial |
$148.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.62
|
| Rate for Payer: 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
|
|
