|
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 |
$274.71
|
| 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 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 |
$274.71
|
| 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 |
$274.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
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 |
$274.71
|
| 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 |
$2.37
|
| 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 |
$2.25
|
| 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
|
$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 |
$2.37
|
| 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 |
$2.25
|
| 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 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
|
OP
|
$346.55
|
|
|
Service Code
|
NDC 68084056121
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.31 |
| 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 |
$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 |
$311.89
|
| 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
|
$346.55
|
|
|
Service Code
|
NDC 68084056121
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.26 |
| Max. Negotiated Rate |
$311.89 |
| 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 |
$311.89
|
| 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: 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
|
$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 68084056111
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.31 |
| 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 |
$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 |
$311.89
|
| 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
|
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
|
$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
|
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
|
$347.10
|
|
|
Service Code
|
NDC 60687058321
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$312.39 |
| Rate for Payer: Aetna Commercial |
$295.04
|
| Rate for Payer: Aetna Medicare |
$90.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.47
|
| Rate for Payer: BCBS Complete |
$138.84
|
| Rate for Payer: BCBS MAPPO |
$86.78
|
| Rate for Payer: BCBS Trust/PPO |
$285.35
|
| Rate for Payer: BCN Commercial |
$269.87
|
| Rate for Payer: BCN Medicare Advantage |
$86.78
|
| 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: Health Alliance Plan Medicare Advantage |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.04
|
| Rate for Payer: Nomi Health Commercial |
$284.62
|
| Rate for Payer: PACE Senior Care Partners |
$82.44
|
| Rate for Payer: PACE SWMI |
$86.78
|
| Rate for Payer: PHP Commercial |
$295.04
|
| Rate for Payer: PHP Medicare Advantage |
$86.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: Priority Health HMO/PPO |
$301.98
|
| Rate for Payer: Priority Health Medicare |
$87.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.56
|
| Rate for Payer: Railroad Medicare Medicare |
$86.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.45
|
| Rate for Payer: UHC Core |
$289.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.78
|
| Rate for Payer: UHC Exchange |
$86.78
|
| Rate for Payer: UHC Medicare Advantage |
$86.78
|
| Rate for Payer: VA VA |
$86.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.32
|
|
|
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 |
$311.89 |
| 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 |
$311.89
|
| 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: 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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 23558007650
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| 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: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: PACE Senior Care Partners |
$2.45
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.09
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.58
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.99
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$5.59
|
| Rate for Payer: BCBS Trust/PPO |
$18.39
|
| Rate for Payer: BCN Commercial |
$17.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.59
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.59
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.31
|
| Rate for Payer: PACE SWMI |
$5.59
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.54
|
| Rate for Payer: Priority Health HMO/PPO |
$19.46
|
| Rate for Payer: Priority Health Medicare |
$5.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.69
|
| Rate for Payer: UHC Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.59
|
| Rate for Payer: UHC Exchange |
$5.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.59
|
| Rate for Payer: VA VA |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
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 |
$6.36 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$7.99
|
| Rate for Payer: BCN Commercial |
$7.57
|
| 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: PHP Commercial |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health HMO/PPO |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.56
|
| 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
|
$9.45
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.71
|
| Rate for Payer: BCN Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health HMO/PPO |
$8.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
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 |
$6.71 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$7.98
|
| 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: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.92
|
| 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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$17.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.40
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.69
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: BCBS Trust/PPO |
$18.26
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.54
|
| Rate for Payer: Priority Health HMO/PPO |
$19.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.69
|
| Rate for Payer: UHC Core |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$17.58
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
