|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$320.15
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$288.14 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,130.50
|
|
|
Service Code
|
NDC 51672404102
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.28 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna American Axle |
$734.82
|
| Rate for Payer: Aetna Commercial |
$960.92
|
| Rate for Payer: Aetna Medicare |
$565.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.82
|
| Rate for Payer: BCBS Complete |
$452.20
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: Cofinity Commercial |
$791.35
|
| Rate for Payer: Cofinity Commercial |
$972.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$791.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.40
|
| Rate for Payer: Healthscope Commercial |
$1,017.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.92
|
| Rate for Payer: PHP Commercial |
$960.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.82
|
| Rate for Payer: Priority Health SBD |
$712.22
|
| Rate for Payer: UMR Bronson Commercial |
$418.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.88
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna American Axle |
$2.04
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.04
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$313.50
|
|
|
Service Code
|
NDC 51079087020
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Commercial |
$219.45
|
| Rate for Payer: Cofinity Commercial |
$269.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.80
|
| Rate for Payer: Healthscope Commercial |
$282.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.48
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.78
|
| Rate for Payer: Priority Health SBD |
$197.50
|
| Rate for Payer: UMR Bronson Commercial |
$137.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.12
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$313.50
|
|
|
Service Code
|
NDC 51079087020
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna Medicare |
$156.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: BCBS Complete |
$125.40
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Commercial |
$219.45
|
| Rate for Payer: Cofinity Commercial |
$269.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.80
|
| Rate for Payer: Healthscope Commercial |
$282.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.48
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.78
|
| Rate for Payer: Priority Health SBD |
$197.50
|
| Rate for Payer: UMR Bronson Commercial |
$116.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.12
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,130.50
|
|
|
Service Code
|
NDC 51672404102
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.42 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna American Axle |
$734.82
|
| Rate for Payer: Aetna Commercial |
$960.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.82
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: Cofinity Commercial |
$791.35
|
| Rate for Payer: Cofinity Commercial |
$972.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$791.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.40
|
| Rate for Payer: Healthscope Commercial |
$1,017.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.92
|
| Rate for Payer: PHP Commercial |
$960.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.82
|
| Rate for Payer: Priority Health SBD |
$712.22
|
| Rate for Payer: UMR Bronson Commercial |
$497.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.88
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$288.14 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna Medicare |
$160.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$118.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$13.07
|
|
|
Service Code
|
NDC 68094000859
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Aetna American Axle |
$8.50
|
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.29
|
|
|
Service Code
|
NDC 00121172410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.48
|
|
|
Service Code
|
NDC 00121189494
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.58
|
| Rate for Payer: Healthscope Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.16
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 00121172410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.48
|
|
|
Service Code
|
NDC 00121189494
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.58
|
| Rate for Payer: Healthscope Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.16
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 00121172430
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.29
|
|
|
Service Code
|
NDC 00121172430
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.48
|
|
|
Service Code
|
NDC 00121189410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.58
|
| Rate for Payer: Healthscope Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.16
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.48
|
|
|
Service Code
|
NDC 00121189410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Commercial |
$8.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.58
|
| Rate for Payer: Healthscope Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.16
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$13.07
|
|
|
Service Code
|
NDC 68094000862
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Aetna American Axle |
$8.50
|
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$13.07
|
|
|
Service Code
|
NDC 68094000862
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Aetna American Axle |
$8.50
|
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$13.07
|
|
|
Service Code
|
NDC 68094000859
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Aetna American Axle |
$8.50
|
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$1,036.37
|
|
|
Service Code
|
NDC 00078050905
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$932.73 |
| Rate for Payer: Aetna American Axle |
$673.64
|
| Rate for Payer: Aetna Commercial |
$880.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.64
|
| Rate for Payer: Cash Price |
$829.10
|
| Rate for Payer: Cofinity Commercial |
$725.46
|
| Rate for Payer: Cofinity Commercial |
$891.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$725.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.10
|
| Rate for Payer: Healthscope Commercial |
$932.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$725.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$777.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.91
|
| Rate for Payer: PHP Commercial |
$880.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.64
|
| Rate for Payer: Priority Health SBD |
$652.91
|
| Rate for Payer: UMR Bronson Commercial |
$456.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.28
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.93
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$109.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$121.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
