Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CAPSAICIN 0.025 % TOPICAL CREAM

Facility

$15.39

Service Code	NDC 00536252525
Hospital Charge Code	1350
Hospital Revenue Code	637
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$13.85
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna New Business (MI Preferred)	$10.00
Rate for Payer: Cash Price	$12.31
Rate for Payer: Cofinity Advantage	$10.77
Rate for Payer: Cofinity Commercial	$13.24
Rate for Payer: Encore Health Key Benefits Commercial	$12.31
Rate for Payer: Healthscope Commercial	$13.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.54
Rate for Payer: PHP Commercial	$13.08
Rate for Payer: Priority Health SBD	$9.70

CAPSAICIN 0.075 % TOPICAL CREAM

Facility

$22.83

Service Code	NDC 00536111825
Hospital Charge Code	9399
Hospital Revenue Code	637
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$20.55
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare	$11.41
Rate for Payer: Aetna New Business (MI Preferred)	$14.84
Rate for Payer: BCBS Complete	$9.13
Rate for Payer: Cash Price	$18.26
Rate for Payer: Cofinity Advantage	$15.98
Rate for Payer: Cofinity Commercial	$19.63
Rate for Payer: Encore Health Key Benefits Commercial	$18.26
Rate for Payer: Healthscope Commercial	$20.55
Rate for Payer: MI Amish Medical Board Commercial	$18.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.12
Rate for Payer: PHP Commercial	$19.41
Rate for Payer: Priority Health SBD	$14.38
Rate for Payer: UHC All Payor (Choice/PPO)	$14.84
Rate for Payer: UHC Core	$11.89
Rate for Payer: UHC Exchange	$8.97

CAPSAICIN 0.075 % TOPICAL CREAM

Facility

$22.83

Service Code	NDC 00536111825
Hospital Charge Code	9399
Hospital Revenue Code	637
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$20.55
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna New Business (MI Preferred)	$14.84
Rate for Payer: Cash Price	$18.26
Rate for Payer: Cofinity Advantage	$15.98
Rate for Payer: Cofinity Commercial	$19.63
Rate for Payer: Encore Health Key Benefits Commercial	$18.26
Rate for Payer: Healthscope Commercial	$20.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.12
Rate for Payer: PHP Commercial	$19.41
Rate for Payer: Priority Health SBD	$14.38

CAPTOPRIL 12.5 MG TABLET

Facility

$621.12

Service Code	NDC 00904710561
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$391.31
Max. Negotiated Rate	$559.01
Rate for Payer: Aetna Commercial	$527.95
Rate for Payer: Aetna New Business (MI Preferred)	$403.73
Rate for Payer: Cash Price	$496.90
Rate for Payer: Cofinity Advantage	$434.78
Rate for Payer: Cofinity Commercial	$534.16
Rate for Payer: Encore Health Key Benefits Commercial	$496.90
Rate for Payer: Healthscope Commercial	$559.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.84
Rate for Payer: PHP Commercial	$527.95
Rate for Payer: Priority Health SBD	$391.31

CAPTOPRIL 12.5 MG TABLET

Facility

$621.12

Service Code	NDC 00904710561
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$244.10
Max. Negotiated Rate	$559.01
Rate for Payer: Aetna Commercial	$527.95
Rate for Payer: Aetna Medicare	$310.56
Rate for Payer: Aetna New Business (MI Preferred)	$403.73
Rate for Payer: BCBS Complete	$248.45
Rate for Payer: Cash Price	$496.90
Rate for Payer: Cofinity Advantage	$434.78
Rate for Payer: Cofinity Commercial	$534.16
Rate for Payer: Encore Health Key Benefits Commercial	$496.90
Rate for Payer: Healthscope Commercial	$559.01
Rate for Payer: MI Amish Medical Board Commercial	$496.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.84
Rate for Payer: PHP Commercial	$527.95
Rate for Payer: Priority Health SBD	$391.31
Rate for Payer: UHC All Payor (Choice/PPO)	$403.73
Rate for Payer: UHC Core	$323.60
Rate for Payer: UHC Exchange	$244.10

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,290.15

Service Code	NDC 51672404709
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$812.79
Max. Negotiated Rate	$1,161.13
Rate for Payer: Aetna Commercial	$1,096.63
Rate for Payer: Aetna New Business (MI Preferred)	$838.60
Rate for Payer: Cash Price	$1,032.12
Rate for Payer: Cofinity Advantage	$903.11
Rate for Payer: Cofinity Commercial	$1,109.53
Rate for Payer: Encore Health Key Benefits Commercial	$1,032.12
Rate for Payer: Healthscope Commercial	$1,161.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,096.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$967.61
Rate for Payer: PHP Commercial	$1,096.63
Rate for Payer: Priority Health SBD	$812.79

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,300.73

Service Code	NDC 60432012916
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$511.19
Max. Negotiated Rate	$1,170.66
Rate for Payer: Aetna Commercial	$1,105.62
Rate for Payer: Aetna Medicare	$650.37
Rate for Payer: Aetna New Business (MI Preferred)	$845.47
Rate for Payer: BCBS Complete	$520.29
Rate for Payer: Cash Price	$1,040.58
Rate for Payer: Cofinity Advantage	$910.51
Rate for Payer: Cofinity Commercial	$1,118.63
Rate for Payer: Encore Health Key Benefits Commercial	$1,040.58
Rate for Payer: Healthscope Commercial	$1,170.66
Rate for Payer: MI Amish Medical Board Commercial	$1,040.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,105.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$975.55
Rate for Payer: PHP Commercial	$1,105.62
Rate for Payer: Priority Health SBD	$819.46
Rate for Payer: UHC All Payor (Choice/PPO)	$845.47
Rate for Payer: UHC Core	$677.68
Rate for Payer: UHC Exchange	$511.19

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,290.15

Service Code	NDC 51672404704
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$812.79
Max. Negotiated Rate	$1,161.13
Rate for Payer: Aetna Commercial	$1,096.63
Rate for Payer: Aetna New Business (MI Preferred)	$838.60
Rate for Payer: Cash Price	$1,032.12
Rate for Payer: Cofinity Advantage	$903.11
Rate for Payer: Cofinity Commercial	$1,109.53
Rate for Payer: Encore Health Key Benefits Commercial	$1,032.12
Rate for Payer: Healthscope Commercial	$1,161.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,096.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$967.61
Rate for Payer: PHP Commercial	$1,096.63
Rate for Payer: Priority Health SBD	$812.79

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,808.33

Service Code	NDC 00078050883
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$710.67
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,537.08
Rate for Payer: Aetna Medicare	$904.16
Rate for Payer: Aetna New Business (MI Preferred)	$1,175.41
Rate for Payer: BCBS Complete	$723.33
Rate for Payer: Cash Price	$1,446.66
Rate for Payer: Cofinity Advantage	$1,265.83
Rate for Payer: Cofinity Commercial	$1,555.16
Rate for Payer: Encore Health Key Benefits Commercial	$1,446.66
Rate for Payer: Healthscope Commercial	$1,627.50
Rate for Payer: MI Amish Medical Board Commercial	$1,446.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,537.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,356.25
Rate for Payer: PHP Commercial	$1,537.08
Rate for Payer: Priority Health SBD	$1,139.25
Rate for Payer: UHC All Payor (Choice/PPO)	$1,175.41
Rate for Payer: UHC Core	$942.14
Rate for Payer: UHC Exchange	$710.67

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,290.15

Service Code	NDC 51672404704
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$507.03
Max. Negotiated Rate	$1,161.13
Rate for Payer: Aetna Commercial	$1,096.63
Rate for Payer: Aetna Medicare	$645.08
Rate for Payer: Aetna New Business (MI Preferred)	$838.60
Rate for Payer: BCBS Complete	$516.06
Rate for Payer: Cash Price	$1,032.12
Rate for Payer: Cofinity Advantage	$903.11
Rate for Payer: Cofinity Commercial	$1,109.53
Rate for Payer: Encore Health Key Benefits Commercial	$1,032.12
Rate for Payer: Healthscope Commercial	$1,161.13
Rate for Payer: MI Amish Medical Board Commercial	$1,032.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,096.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$967.61
Rate for Payer: PHP Commercial	$1,096.63
Rate for Payer: Priority Health SBD	$812.79
Rate for Payer: UHC All Payor (Choice/PPO)	$838.60
Rate for Payer: UHC Core	$672.17
Rate for Payer: UHC Exchange	$507.03

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,290.15

Service Code	NDC 51672404709
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$507.03
Max. Negotiated Rate	$1,161.13
Rate for Payer: Aetna Commercial	$1,096.63
Rate for Payer: Aetna Medicare	$645.08
Rate for Payer: Aetna New Business (MI Preferred)	$838.60
Rate for Payer: BCBS Complete	$516.06
Rate for Payer: Cash Price	$1,032.12
Rate for Payer: Cofinity Advantage	$903.11
Rate for Payer: Cofinity Commercial	$1,109.53
Rate for Payer: Encore Health Key Benefits Commercial	$1,032.12
Rate for Payer: Healthscope Commercial	$1,161.13
Rate for Payer: MI Amish Medical Board Commercial	$1,032.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,096.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$967.61
Rate for Payer: PHP Commercial	$1,096.63
Rate for Payer: Priority Health SBD	$812.79
Rate for Payer: UHC All Payor (Choice/PPO)	$838.60
Rate for Payer: UHC Core	$672.17
Rate for Payer: UHC Exchange	$507.03

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$13.75

Service Code	NDC 09900000935
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Advantage	$9.62
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.31
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health SBD	$8.66

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,808.33

Service Code	NDC 00078050883
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$1,139.25
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,537.08
Rate for Payer: Aetna New Business (MI Preferred)	$1,175.41
Rate for Payer: Cash Price	$1,446.66
Rate for Payer: Cofinity Advantage	$1,265.83
Rate for Payer: Cofinity Commercial	$1,555.16
Rate for Payer: Encore Health Key Benefits Commercial	$1,446.66
Rate for Payer: Healthscope Commercial	$1,627.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,537.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,356.25
Rate for Payer: PHP Commercial	$1,537.08
Rate for Payer: Priority Health SBD	$1,139.25

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$13.75

Service Code	NDC 09900000935
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna Medicare	$6.88
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: BCBS Complete	$5.50
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Advantage	$9.62
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Encore Health Key Benefits Commercial	$11.00
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: MI Amish Medical Board Commercial	$11.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.31
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health SBD	$8.66
Rate for Payer: UHC All Payor (Choice/PPO)	$8.94
Rate for Payer: UHC Core	$7.16
Rate for Payer: UHC Exchange	$5.40

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,300.73

Service Code	NDC 60432012916
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$819.46
Max. Negotiated Rate	$1,170.66
Rate for Payer: Aetna Commercial	$1,105.62
Rate for Payer: Aetna New Business (MI Preferred)	$845.47
Rate for Payer: Cash Price	$1,040.58
Rate for Payer: Cofinity Advantage	$910.51
Rate for Payer: Cofinity Commercial	$1,118.63
Rate for Payer: Encore Health Key Benefits Commercial	$1,040.58
Rate for Payer: Healthscope Commercial	$1,170.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,105.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$975.55
Rate for Payer: PHP Commercial	$1,105.62
Rate for Payer: Priority Health SBD	$819.46

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$378.10

Service Code	NDC 00904385461
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$148.59
Max. Negotiated Rate	$340.29
Rate for Payer: Aetna Commercial	$321.38
Rate for Payer: Aetna Medicare	$189.05
Rate for Payer: Aetna New Business (MI Preferred)	$245.76
Rate for Payer: BCBS Complete	$151.24
Rate for Payer: Cash Price	$302.48
Rate for Payer: Cofinity Advantage	$264.67
Rate for Payer: Cofinity Commercial	$325.17
Rate for Payer: Encore Health Key Benefits Commercial	$302.48
Rate for Payer: Healthscope Commercial	$340.29
Rate for Payer: MI Amish Medical Board Commercial	$302.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.57
Rate for Payer: PHP Commercial	$321.38
Rate for Payer: Priority Health SBD	$238.20
Rate for Payer: UHC All Payor (Choice/PPO)	$245.76
Rate for Payer: UHC Core	$196.99
Rate for Payer: UHC Exchange	$148.59

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$313.50

Service Code	NDC 51079087020
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$123.21
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna Medicare	$156.75
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: BCBS Complete	$125.40
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Advantage	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Encore Health Key Benefits Commercial	$250.80
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: MI Amish Medical Board Commercial	$250.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$266.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.12
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health SBD	$197.50
Rate for Payer: UHC All Payor (Choice/PPO)	$203.78
Rate for Payer: UHC Core	$163.33
Rate for Payer: UHC Exchange	$123.21

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$378.10

Service Code	NDC 00904385461
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$238.20
Max. Negotiated Rate	$340.29
Rate for Payer: Aetna Commercial	$321.38
Rate for Payer: Aetna New Business (MI Preferred)	$245.76
Rate for Payer: Cash Price	$302.48
Rate for Payer: Cofinity Advantage	$264.67
Rate for Payer: Cofinity Commercial	$325.17
Rate for Payer: Encore Health Key Benefits Commercial	$302.48
Rate for Payer: Healthscope Commercial	$340.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.57
Rate for Payer: PHP Commercial	$321.38
Rate for Payer: Priority Health SBD	$238.20

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$313.50

Service Code	NDC 51079087020
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Advantage	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Encore Health Key Benefits Commercial	$250.80
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$266.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.12
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health SBD	$197.50

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$3.14

Service Code	NDC 51079087001
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Advantage	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.35
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health SBD	$1.98

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$3.14

Service Code	NDC 51079087001
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare	$1.57
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: BCBS Complete	$1.26
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Advantage	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: MI Amish Medical Board Commercial	$2.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.35
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health SBD	$1.98
Rate for Payer: UHC All Payor (Choice/PPO)	$2.04
Rate for Payer: UHC Core	$1.64
Rate for Payer: UHC Exchange	$1.23

CARBAMAZEPINE 200 MG TABLET

Facility

$247.68

Service Code	NDC 00904617261
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$156.04
Max. Negotiated Rate	$222.91
Rate for Payer: Aetna Commercial	$210.53
Rate for Payer: Aetna New Business (MI Preferred)	$160.99
Rate for Payer: Cash Price	$198.14
Rate for Payer: Cofinity Advantage	$173.38
Rate for Payer: Cofinity Commercial	$213.00
Rate for Payer: Encore Health Key Benefits Commercial	$198.14
Rate for Payer: Healthscope Commercial	$222.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.76
Rate for Payer: PHP Commercial	$210.53
Rate for Payer: Priority Health SBD	$156.04

CARBAMAZEPINE 200 MG TABLET

Facility

$1,094.09

Service Code	NDC 00078050905
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$689.28
Max. Negotiated Rate	$984.68
Rate for Payer: Aetna Commercial	$929.98
Rate for Payer: Aetna New Business (MI Preferred)	$711.16
Rate for Payer: Cash Price	$875.27
Rate for Payer: Cofinity Advantage	$765.86
Rate for Payer: Cofinity Commercial	$940.92
Rate for Payer: Encore Health Key Benefits Commercial	$875.27
Rate for Payer: Healthscope Commercial	$984.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$929.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$820.57
Rate for Payer: PHP Commercial	$929.98
Rate for Payer: Priority Health SBD	$689.28

CARBAMAZEPINE 200 MG TABLET

Facility

$1,094.09

Service Code	NDC 00078050905
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$429.98
Max. Negotiated Rate	$984.68
Rate for Payer: Aetna Commercial	$929.98
Rate for Payer: Aetna Medicare	$547.04
Rate for Payer: Aetna New Business (MI Preferred)	$711.16
Rate for Payer: BCBS Complete	$437.64
Rate for Payer: Cash Price	$875.27
Rate for Payer: Cofinity Advantage	$765.86
Rate for Payer: Cofinity Commercial	$940.92
Rate for Payer: Encore Health Key Benefits Commercial	$875.27
Rate for Payer: Healthscope Commercial	$984.68
Rate for Payer: MI Amish Medical Board Commercial	$875.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$929.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$820.57
Rate for Payer: PHP Commercial	$929.98
Rate for Payer: Priority Health SBD	$689.28
Rate for Payer: UHC All Payor (Choice/PPO)	$711.16
Rate for Payer: UHC Core	$570.02
Rate for Payer: UHC Exchange	$429.98

CARBAMAZEPINE 200 MG TABLET

Facility

$361.00

Service Code	NDC 51672400501
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$141.87
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna Medicare	$180.50
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: BCBS Complete	$144.40
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Advantage	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Encore Health Key Benefits Commercial	$288.80
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: MI Amish Medical Board Commercial	$288.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.75
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health SBD	$227.43
Rate for Payer: UHC All Payor (Choice/PPO)	$234.65
Rate for Payer: UHC Core	$188.08
Rate for Payer: UHC Exchange	$141.87

Know your out-of-pocket cost for care.

All Charges