|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$100.11
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna Commercial |
$85.09
|
| Rate for Payer: Aetna Medicare |
$26.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS MAPPO |
$25.03
|
| Rate for Payer: BCBS Trust/PPO |
$82.30
|
| Rate for Payer: BCN Commercial |
$82.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.03
|
| Rate for Payer: Cash Price |
$80.09
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$90.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.08
|
| Rate for Payer: Mclaren Medicaid |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.28
|
| Rate for Payer: Meridian Medicaid |
$18.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.09
|
| Rate for Payer: Nomi Health Commercial |
$82.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.08
|
| Rate for Payer: PACE Senior Care Partners |
$23.78
|
| Rate for Payer: PACE SWMI |
$25.03
|
| Rate for Payer: PHP Commercial |
$85.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.10
|
| Rate for Payer: Priority Health Medicare |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.68
|
| Rate for Payer: Railroad Medicare Medicare |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.10
|
| Rate for Payer: UHC Core |
$83.59
|
| Rate for Payer: UHC Exchange |
$25.03
|
| Rate for Payer: UHC Medicaid |
$17.65
|
| Rate for Payer: UHC Medicare Advantage |
$25.03
|
| Rate for Payer: UHCCP Medicaid |
$17.65
|
| Rate for Payer: VA VA |
$25.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.08
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
NDC 23900000361
|
| Hospital Charge Code |
76967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$3.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Medicaid |
$3.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHCCP Medicaid |
$3.45
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
NDC 23900000361
|
| Hospital Charge Code |
76967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$247.68
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.39 |
| Max. Negotiated Rate |
$222.91 |
| Rate for Payer: Aetna Commercial |
$210.53
|
| Rate for Payer: BCBS Trust/PPO |
$204.56
|
| Rate for Payer: BCN Commercial |
$204.56
|
| Rate for Payer: Cash Price |
$198.14
|
| 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: Lakeland Regional Health Systems Commercial |
$185.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Nomi Health Commercial |
$203.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: PHP Commercial |
$210.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.96
|
| Rate for Payer: UHC Core |
$206.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.76
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084044411
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 13668026801
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$85.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.81
|
| Rate for Payer: BCBS Complete |
$60.90
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$270.47
|
| Rate for Payer: BCN Medicare Advantage |
$82.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.25
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Mclaren Medicaid |
$58.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: Meridian Medicaid |
$60.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PACE Senior Care Partners |
$78.14
|
| Rate for Payer: PACE SWMI |
$82.25
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: PHP Medicare Advantage |
$82.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.98
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicaid |
$58.00
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: UHCCP Medicaid |
$58.00
|
| Rate for Payer: VA VA |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$272.64
|
|
|
Service Code
|
NDC 68084044401
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.74
|
| Rate for Payer: Aetna Medicare |
$70.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.20
|
| Rate for Payer: BCBS Complete |
$50.47
|
| Rate for Payer: BCBS MAPPO |
$68.16
|
| Rate for Payer: BCBS Trust/PPO |
$224.14
|
| Rate for Payer: BCN Commercial |
$224.14
|
| Rate for Payer: BCN Medicare Advantage |
$68.16
|
| Rate for Payer: Cash Price |
$218.11
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.16
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.48
|
| Rate for Payer: Mclaren Medicaid |
$48.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.57
|
| Rate for Payer: Meridian Medicaid |
$50.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.74
|
| Rate for Payer: Nomi Health Commercial |
$223.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.48
|
| Rate for Payer: PACE Senior Care Partners |
$64.75
|
| Rate for Payer: PACE SWMI |
$68.16
|
| Rate for Payer: PHP Commercial |
$231.74
|
| Rate for Payer: PHP Medicare Advantage |
$68.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.20
|
| Rate for Payer: Priority Health Medicare |
$68.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.76
|
| Rate for Payer: Railroad Medicare Medicare |
$68.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.92
|
| Rate for Payer: UHC Core |
$227.65
|
| Rate for Payer: UHC Exchange |
$68.16
|
| Rate for Payer: UHC Medicaid |
$48.07
|
| Rate for Payer: UHC Medicare Advantage |
$68.16
|
| Rate for Payer: UHCCP Medicaid |
$48.07
|
| Rate for Payer: VA VA |
$68.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.48
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$247.68
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$222.91 |
| Rate for Payer: Aetna Commercial |
$210.53
|
| Rate for Payer: Aetna Medicare |
$64.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.40
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS MAPPO |
$61.92
|
| Rate for Payer: BCBS Trust/PPO |
$203.62
|
| Rate for Payer: BCN Commercial |
$203.62
|
| Rate for Payer: BCN Medicare Advantage |
$61.92
|
| Rate for Payer: Cash Price |
$198.14
|
| Rate for Payer: Cofinity Commercial |
$213.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$222.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.76
|
| Rate for Payer: Mclaren Medicaid |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.02
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Nomi Health Commercial |
$203.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: PACE Senior Care Partners |
$58.82
|
| Rate for Payer: PACE SWMI |
$61.92
|
| Rate for Payer: PHP Commercial |
$210.53
|
| Rate for Payer: PHP Medicare Advantage |
$61.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.48
|
| Rate for Payer: Priority Health Medicare |
$62.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.39
|
| Rate for Payer: Railroad Medicare Medicare |
$61.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.96
|
| Rate for Payer: UHC Core |
$206.81
|
| Rate for Payer: UHC Exchange |
$61.92
|
| Rate for Payer: UHC Medicaid |
$43.67
|
| Rate for Payer: UHC Medicare Advantage |
$61.92
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
| Rate for Payer: VA VA |
$61.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.76
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 68084044411
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: Meridian Medicaid |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$2.28
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.68
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 13668026801
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.98 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$271.72
|
| Rate for Payer: BCN Commercial |
$271.72
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.98 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$271.72
|
| Rate for Payer: BCN Commercial |
$271.72
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$272.64
|
|
|
Service Code
|
NDC 68084044401
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.76 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.74
|
| Rate for Payer: BCBS Trust/PPO |
$225.17
|
| Rate for Payer: BCN Commercial |
$225.17
|
| Rate for Payer: Cash Price |
$218.11
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.11
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.74
|
| Rate for Payer: Nomi Health Commercial |
$223.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.48
|
| Rate for Payer: PHP Commercial |
$231.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.92
|
| Rate for Payer: UHC Core |
$227.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.48
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$85.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.81
|
| Rate for Payer: BCBS Complete |
$60.90
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$270.47
|
| Rate for Payer: BCN Medicare Advantage |
$82.25
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.25
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Mclaren Medicaid |
$58.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: Meridian Medicaid |
$60.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PACE Senior Care Partners |
$78.14
|
| Rate for Payer: PACE SWMI |
$82.25
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: PHP Medicare Advantage |
$82.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.98
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.71
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicaid |
$58.00
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: UHCCP Medicaid |
$58.00
|
| Rate for Payer: VA VA |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$346.55
|
|
|
Service Code
|
NDC 68084056121
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$311.89 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: Aetna Medicare |
$90.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.30
|
| Rate for Payer: BCBS Complete |
$64.15
|
| Rate for Payer: BCBS MAPPO |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$284.90
|
| Rate for Payer: BCN Commercial |
$284.90
|
| Rate for Payer: BCN Medicare Advantage |
$86.64
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Mclaren Medicaid |
$61.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.97
|
| Rate for Payer: Meridian Medicaid |
$64.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.91
|
| Rate for Payer: PACE Senior Care Partners |
$82.31
|
| Rate for Payer: PACE SWMI |
$86.64
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: PHP Medicare Advantage |
$86.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.20
|
| Rate for Payer: Railroad Medicare Medicare |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: UHC Exchange |
$86.64
|
| Rate for Payer: UHC Medicaid |
$61.10
|
| Rate for Payer: UHC Medicare Advantage |
$86.64
|
| Rate for Payer: UHCCP Medicaid |
$61.10
|
| Rate for Payer: VA VA |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$346.55
|
|
|
Service Code
|
NDC 68084056121
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$311.89 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$286.22
|
| Rate for Payer: BCN Commercial |
$286.22
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.91
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCN Commercial |
$10.79
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Nomi Health Commercial |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.49
|
| Rate for Payer: UHC Core |
$10.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$391.72
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$352.55 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: BCBS Trust/PPO |
$323.52
|
| Rate for Payer: BCN Commercial |
$323.52
|
| Rate for Payer: Cash Price |
$313.38
|
| Rate for Payer: Cofinity Commercial |
$336.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.38
|
| Rate for Payer: Healthscope Commercial |
$352.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.96
|
| Rate for Payer: Nomi Health Commercial |
$321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.79
|
| Rate for Payer: PHP Commercial |
$332.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$340.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.71
|
| Rate for Payer: UHC Core |
$327.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.79
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$346.55
|
|
|
Service Code
|
NDC 68084056111
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$311.89 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$286.22
|
| Rate for Payer: BCN Commercial |
$286.22
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.91
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$401.76
|
|
|
Service Code
|
NDC 51672412401
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$104.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.55
|
| Rate for Payer: BCBS Complete |
$74.37
|
| Rate for Payer: BCBS MAPPO |
$100.44
|
| Rate for Payer: BCBS Trust/PPO |
$330.29
|
| Rate for Payer: BCN Commercial |
$330.29
|
| Rate for Payer: BCN Medicare Advantage |
$100.44
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.44
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Mclaren Medicaid |
$70.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.46
|
| Rate for Payer: Meridian Medicaid |
$74.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Nomi Health Commercial |
$329.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PACE Senior Care Partners |
$95.42
|
| Rate for Payer: PACE SWMI |
$100.44
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: PHP Medicare Advantage |
$100.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$349.53
|
| Rate for Payer: Priority Health Medicare |
$101.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.62
|
| Rate for Payer: Railroad Medicare Medicare |
$100.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.55
|
| Rate for Payer: UHC Core |
$335.47
|
| Rate for Payer: UHC Exchange |
$100.44
|
| Rate for Payer: UHC Medicaid |
$70.83
|
| Rate for Payer: UHC Medicare Advantage |
$100.44
|
| Rate for Payer: UHCCP Medicaid |
$70.83
|
| Rate for Payer: VA VA |
$100.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$13.06
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCN Commercial |
$10.74
|
| Rate for Payer: BCN Medicare Advantage |
$3.27
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.43
|
| Rate for Payer: Meridian Medicaid |
$2.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Nomi Health Commercial |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: PACE Senior Care Partners |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.27
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: PHP Medicare Advantage |
$3.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.36
|
| Rate for Payer: Priority Health Medicare |
$3.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.49
|
| Rate for Payer: UHC Core |
$10.91
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UHC Medicaid |
$2.30
|
| Rate for Payer: UHC Medicare Advantage |
$3.27
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$391.72
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.06 |
| Max. Negotiated Rate |
$352.55 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Medicare |
$101.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.41
|
| Rate for Payer: BCBS Complete |
$72.51
|
| Rate for Payer: BCBS MAPPO |
$97.93
|
| Rate for Payer: BCBS Trust/PPO |
$322.03
|
| Rate for Payer: BCN Commercial |
$322.03
|
| Rate for Payer: BCN Medicare Advantage |
$97.93
|
| Rate for Payer: Cash Price |
$313.38
|
| Rate for Payer: Cofinity Commercial |
$336.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.93
|
| Rate for Payer: Healthscope Commercial |
$352.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.79
|
| Rate for Payer: Mclaren Medicaid |
$69.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.83
|
| Rate for Payer: Meridian Medicaid |
$72.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.96
|
| Rate for Payer: Nomi Health Commercial |
$321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.79
|
| Rate for Payer: PACE Senior Care Partners |
$93.03
|
| Rate for Payer: PACE SWMI |
$97.93
|
| Rate for Payer: PHP Commercial |
$332.96
|
| Rate for Payer: PHP Medicare Advantage |
$97.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$340.80
|
| Rate for Payer: Priority Health Medicare |
$98.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.64
|
| Rate for Payer: Railroad Medicare Medicare |
$97.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.71
|
| Rate for Payer: UHC Core |
$327.09
|
| Rate for Payer: UHC Exchange |
$97.93
|
| Rate for Payer: UHC Medicaid |
$69.06
|
| Rate for Payer: UHC Medicare Advantage |
$97.93
|
| Rate for Payer: UHCCP Medicaid |
$69.06
|
| Rate for Payer: VA VA |
$97.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.79
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$346.55
|
|
|
Service Code
|
NDC 68084056111
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$311.89 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: Aetna Medicare |
$90.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.30
|
| Rate for Payer: BCBS Complete |
$64.15
|
| Rate for Payer: BCBS MAPPO |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$284.90
|
| Rate for Payer: BCN Commercial |
$284.90
|
| Rate for Payer: BCN Medicare Advantage |
$86.64
|
| Rate for Payer: Cash Price |
$277.24
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.64
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Mclaren Medicaid |
$61.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.97
|
| Rate for Payer: Meridian Medicaid |
$64.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.91
|
| Rate for Payer: PACE Senior Care Partners |
$82.31
|
| Rate for Payer: PACE SWMI |
$86.64
|
| Rate for Payer: PHP Commercial |
$294.57
|
| Rate for Payer: PHP Medicare Advantage |
$86.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.20
|
| Rate for Payer: Railroad Medicare Medicare |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.96
|
| Rate for Payer: UHC Core |
$289.37
|
| Rate for Payer: UHC Exchange |
$86.64
|
| Rate for Payer: UHC Medicaid |
$61.10
|
| Rate for Payer: UHC Medicare Advantage |
$86.64
|
| Rate for Payer: UHCCP Medicaid |
$61.10
|
| Rate for Payer: VA VA |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
NDC 51672412401
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.62 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: BCBS Trust/PPO |
$331.81
|
| Rate for Payer: BCN Commercial |
$331.81
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Nomi Health Commercial |
$329.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$349.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.55
|
| Rate for Payer: UHC Core |
$335.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 23558076501
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Commercial |
$8.09
|
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.32
|
| Rate for Payer: Nomi Health Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.34
|
| Rate for Payer: PHP Commercial |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.62
|
| Rate for Payer: UHC Core |
$8.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.34
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 23558007650
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.53
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.75
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
