|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: PACE Senior Care Partners |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.62
|
| Rate for Payer: UHC Core |
$3.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.03
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$70.83
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: PHP Commercial |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.62
|
| Rate for Payer: UHC Core |
$3.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.64
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: BCBS MAPPO |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.35
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: BCN Medicare Advantage |
$22.91
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PACE Senior Care Partners |
$21.77
|
| Rate for Payer: PACE SWMI |
$22.91
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: Railroad Medicare Medicare |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.91
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicare Advantage |
$22.91
|
| Rate for Payer: VA VA |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.12
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.54
|
| Rate for Payer: BCN Medicare Advantage |
$51.30
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PACE Senior Care Partners |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.30
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Medicare |
$51.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.30
|
| Rate for Payer: UHC Exchange |
$51.30
|
| Rate for Payer: UHC Medicare Advantage |
$51.30
|
| Rate for Payer: VA VA |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
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 |
$4.65 |
| 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 |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: BCN Medicare Advantage |
$4.90
|
| 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 |
$4.90
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.90
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.90
|
| Rate for Payer: UHC Exchange |
$4.90
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: VA VA |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
|
|
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 |
$12.73 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.13
|
| 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 |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| 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 |
$14.68
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$2.75
|
|
|
Service Code
|
NDC 68084044411
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.69
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: PHP Medicare Advantage |
$0.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2.39
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.69
|
| Rate for Payer: VA VA |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 13668026801
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$268.56
|
| Rate for Payer: BCN Commercial |
$254.25
|
| 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: 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: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$2.75
|
|
|
Service Code
|
NDC 68084044411
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO |
$2.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 13668026801
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| 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 |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$255.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| 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 Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.25
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: VA VA |
$82.25
|
| 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 |
$213.85 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: BCBS Trust/PPO |
$268.56
|
| Rate for Payer: BCN Commercial |
$254.25
|
| 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: 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: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$274.08
|
|
|
Service Code
|
NDC 68084044401
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.09 |
| Max. Negotiated Rate |
$246.67 |
| Rate for Payer: Aetna Commercial |
$232.97
|
| Rate for Payer: Aetna Medicare |
$71.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.65
|
| Rate for Payer: BCBS Complete |
$109.63
|
| Rate for Payer: BCBS MAPPO |
$68.52
|
| Rate for Payer: BCBS Trust/PPO |
$225.32
|
| Rate for Payer: BCN Commercial |
$213.10
|
| Rate for Payer: BCN Medicare Advantage |
$68.52
|
| Rate for Payer: Cash Price |
$219.26
|
| Rate for Payer: Cofinity Commercial |
$235.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.52
|
| Rate for Payer: Healthscope Commercial |
$246.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.97
|
| Rate for Payer: Nomi Health Commercial |
$224.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.09
|
| Rate for Payer: PACE SWMI |
$68.52
|
| Rate for Payer: PHP Commercial |
$232.97
|
| Rate for Payer: PHP Medicare Advantage |
$68.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.15
|
| Rate for Payer: Priority Health HMO/PPO |
$238.45
|
| Rate for Payer: Priority Health Medicare |
$69.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.63
|
| Rate for Payer: Railroad Medicare Medicare |
$68.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.19
|
| Rate for Payer: UHC Core |
$228.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.52
|
| Rate for Payer: UHC Exchange |
$68.52
|
| Rate for Payer: UHC Medicare Advantage |
$68.52
|
| Rate for Payer: VA VA |
$68.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.56
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| 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 |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$270.47
|
| Rate for Payer: BCN Commercial |
$255.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Nomi Health Commercial |
$269.78
|
| 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 Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO |
$286.23
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.43
|
| Rate for Payer: Railroad Medicare Medicare |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.52
|
| Rate for Payer: UHC Core |
$274.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.25
|
| Rate for Payer: UHC Exchange |
$82.25
|
| Rate for Payer: UHC Medicare Advantage |
$82.25
|
| Rate for Payer: VA VA |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$274.08
|
|
|
Service Code
|
NDC 68084044401
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.15 |
| Max. Negotiated Rate |
$246.67 |
| Rate for Payer: Aetna Commercial |
$232.97
|
| Rate for Payer: BCBS Trust/PPO |
$223.73
|
| Rate for Payer: BCN Commercial |
$211.81
|
| Rate for Payer: Cash Price |
$219.26
|
| Rate for Payer: Cofinity Commercial |
$235.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.26
|
| Rate for Payer: Healthscope Commercial |
$246.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.97
|
| Rate for Payer: Nomi Health Commercial |
$224.75
|
| Rate for Payer: PHP Commercial |
$232.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.15
|
| Rate for Payer: Priority Health HMO/PPO |
$238.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.19
|
| Rate for Payer: UHC Core |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.56
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$11.57
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$10.41 |
| Rate for Payer: Aetna Commercial |
$9.83
|
| Rate for Payer: BCBS Trust/PPO |
$9.44
|
| Rate for Payer: BCN Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$9.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.26
|
| Rate for Payer: Healthscope Commercial |
$10.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: PHP Commercial |
$9.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: Priority Health HMO/PPO |
$10.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.18
|
| Rate for Payer: UHC Core |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.68
|
|
|
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 |
$82.31 |
| Max. Negotiated Rate |
$311.90 |
| 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 |
$138.62
|
| Rate for Payer: BCBS MAPPO |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$284.90
|
| Rate for Payer: BCN Commercial |
$269.44
|
| 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 |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| 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 Cigna Priority Health |
$225.26
|
| Rate for Payer: Priority Health HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| 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 Dual Complete DSNP |
$86.64
|
| Rate for Payer: UHC Exchange |
$86.64
|
| Rate for Payer: UHC Medicare Advantage |
$86.64
|
| 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 |
$261.14 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: BCBS Trust/PPO |
$327.96
|
| Rate for Payer: BCN Commercial |
$310.48
|
| 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: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health HMO/PPO |
$349.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.18
|
| 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
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$11.57
|
|
|
Service Code
|
NDC 60687058311
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.41 |
| Rate for Payer: Aetna Commercial |
$9.83
|
| Rate for Payer: Aetna Medicare |
$3.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.62
|
| Rate for Payer: BCBS Complete |
$4.63
|
| Rate for Payer: BCBS MAPPO |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$9.51
|
| Rate for Payer: BCN Commercial |
$9.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.89
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$9.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$10.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.83
|
| Rate for Payer: Nomi Health Commercial |
$9.49
|
| Rate for Payer: PACE Senior Care Partners |
$2.75
|
| Rate for Payer: PACE SWMI |
$2.89
|
| Rate for Payer: PHP Commercial |
$9.83
|
| Rate for Payer: PHP Medicare Advantage |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: Priority Health HMO/PPO |
$10.07
|
| Rate for Payer: Priority Health Medicare |
$2.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.18
|
| Rate for Payer: UHC Core |
$9.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.89
|
| Rate for Payer: UHC Medicare Advantage |
$2.89
|
| Rate for Payer: VA VA |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.68
|
|
|
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 |
$225.26 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$267.81
|
| 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 |
$311.90
|
| 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: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.26
|
| Rate for Payer: Priority Health HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| 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 |
$95.42 |
| 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 |
$160.70
|
| Rate for Payer: BCBS MAPPO |
$100.44
|
| Rate for Payer: BCBS Trust/PPO |
$330.29
|
| Rate for Payer: BCN Commercial |
$312.37
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Nomi Health Commercial |
$329.44
|
| 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 Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health HMO/PPO |
$349.53
|
| Rate for Payer: Priority Health Medicare |
$101.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.18
|
| 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 Dual Complete DSNP |
$100.44
|
| Rate for Payer: UHC Exchange |
$100.44
|
| Rate for Payer: UHC Medicare Advantage |
$100.44
|
| 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
|
IP
|
$346.55
|
|
|
Service Code
|
NDC 68084056121
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.26 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Aetna Commercial |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$267.81
|
| 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 |
$311.90
|
| 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: PHP Commercial |
$294.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.26
|
| Rate for Payer: Priority Health HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| 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
|
$347.10
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.62 |
| Max. Negotiated Rate |
$312.39 |
| Rate for Payer: Aetna Commercial |
$295.04
|
| Rate for Payer: BCBS Trust/PPO |
$283.34
|
| Rate for Payer: BCN Commercial |
$268.24
|
| Rate for Payer: Cash Price |
$277.68
|
| Rate for Payer: Cofinity Commercial |
$298.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.68
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.04
|
| Rate for Payer: Nomi Health Commercial |
$284.62
|
| Rate for Payer: PHP Commercial |
$295.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: Priority Health HMO/PPO |
$301.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.45
|
| Rate for Payer: UHC Core |
$289.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.32
|
|
|
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 |
$82.31 |
| Max. Negotiated Rate |
$311.90 |
| 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 |
$138.62
|
| Rate for Payer: BCBS MAPPO |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$284.90
|
| Rate for Payer: BCN Commercial |
$269.44
|
| 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 |
$311.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.57
|
| Rate for Payer: Nomi Health Commercial |
$284.17
|
| 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 Cigna Priority Health |
$225.26
|
| Rate for Payer: Priority Health HMO/PPO |
$301.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.19
|
| 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 Dual Complete DSNP |
$86.64
|
| Rate for Payer: UHC Exchange |
$86.64
|
| Rate for Payer: UHC Medicare Advantage |
$86.64
|
| Rate for Payer: VA VA |
$86.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.91
|
|
