|
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
|
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
|
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
|
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
|
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/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
|
$9.29
|
|
|
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 TABLET
|
Facility
|
OP
|
$1,036.37
|
|
|
Service Code
|
NDC 00078050905
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.46 |
| Max. Negotiated Rate |
$932.73 |
| Rate for Payer: Aetna American Axle |
$673.64
|
| Rate for Payer: Aetna Commercial |
$880.91
|
| Rate for Payer: Aetna Medicare |
$518.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.64
|
| Rate for Payer: BCBS Complete |
$414.55
|
| 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 |
$383.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.28
|
|
|
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
|
|
|
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
|
$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
|
$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
|
$249.12
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna Medicare |
$124.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: BCBS Complete |
$99.65
|
| 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 |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$698.69
|
|
|
Service Code
|
NDC 60505280507
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.42 |
| Max. Negotiated Rate |
$628.82 |
| Rate for Payer: Aetna American Axle |
$454.15
|
| Rate for Payer: Aetna Commercial |
$593.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.15
|
| Rate for Payer: Cash Price |
$558.95
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Cofinity Commercial |
$600.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.95
|
| Rate for Payer: Healthscope Commercial |
$628.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.89
|
| Rate for Payer: PHP Commercial |
$593.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| Rate for Payer: Priority Health SBD |
$440.17
|
| Rate for Payer: UMR Bronson Commercial |
$307.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$878.40
|
|
|
Service Code
|
NDC 66993040732
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.01 |
| Max. Negotiated Rate |
$790.56 |
| Rate for Payer: Aetna American Axle |
$570.96
|
| Rate for Payer: Aetna Commercial |
$746.64
|
| Rate for Payer: Aetna Medicare |
$439.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.96
|
| Rate for Payer: BCBS Complete |
$351.36
|
| Rate for Payer: Cash Price |
$702.72
|
| Rate for Payer: Cofinity Commercial |
$614.88
|
| Rate for Payer: Cofinity Commercial |
$755.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$702.72
|
| Rate for Payer: Healthscope Commercial |
$790.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$614.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$658.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.64
|
| Rate for Payer: PHP Commercial |
$746.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.96
|
| Rate for Payer: Priority Health SBD |
$553.39
|
| Rate for Payer: UMR Bronson Commercial |
$325.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$658.80
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$878.40
|
|
|
Service Code
|
NDC 66993040732
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$790.56 |
| Rate for Payer: Aetna American Axle |
$570.96
|
| Rate for Payer: Aetna Commercial |
$746.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.96
|
| Rate for Payer: Cash Price |
$702.72
|
| Rate for Payer: Cofinity Commercial |
$614.88
|
| Rate for Payer: Cofinity Commercial |
$755.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$702.72
|
| Rate for Payer: Healthscope Commercial |
$790.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$614.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$658.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.64
|
| Rate for Payer: PHP Commercial |
$746.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.96
|
| Rate for Payer: Priority Health SBD |
$553.39
|
| Rate for Payer: UMR Bronson Commercial |
$386.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$658.80
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$698.69
|
|
|
Service Code
|
NDC 60505280507
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$628.82 |
| Rate for Payer: Aetna American Axle |
$454.15
|
| Rate for Payer: Aetna Commercial |
$593.89
|
| Rate for Payer: Aetna Medicare |
$349.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.15
|
| Rate for Payer: BCBS Complete |
$279.48
|
| Rate for Payer: Cash Price |
$558.95
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Cofinity Commercial |
$600.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.95
|
| Rate for Payer: Healthscope Commercial |
$628.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.89
|
| Rate for Payer: PHP Commercial |
$593.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| Rate for Payer: Priority Health SBD |
$440.17
|
| Rate for Payer: UMR Bronson Commercial |
$258.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 50742025701
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 50742025701
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$719.52
|
|
|
Service Code
|
NDC 00078051005
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.59 |
| Max. Negotiated Rate |
$647.57 |
| Rate for Payer: Aetna American Axle |
$467.69
|
| Rate for Payer: Aetna Commercial |
$611.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.69
|
| Rate for Payer: Cash Price |
$575.62
|
| Rate for Payer: Cofinity Commercial |
$503.66
|
| Rate for Payer: Cofinity Commercial |
$618.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.62
|
| Rate for Payer: Healthscope Commercial |
$647.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.59
|
| Rate for Payer: PHP Commercial |
$611.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.69
|
| Rate for Payer: Priority Health SBD |
$453.30
|
| Rate for Payer: UMR Bronson Commercial |
$316.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.64
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$719.52
|
|
|
Service Code
|
NDC 00078051005
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.22 |
| Max. Negotiated Rate |
$647.57 |
| Rate for Payer: Aetna American Axle |
$467.69
|
| Rate for Payer: Aetna Commercial |
$611.59
|
| Rate for Payer: Aetna Medicare |
$359.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.69
|
| Rate for Payer: BCBS Complete |
$287.81
|
| Rate for Payer: Cash Price |
$575.62
|
| Rate for Payer: Cofinity Commercial |
$503.66
|
| Rate for Payer: Cofinity Commercial |
$618.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.62
|
| Rate for Payer: Healthscope Commercial |
$647.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.59
|
| Rate for Payer: PHP Commercial |
$611.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.69
|
| Rate for Payer: Priority Health SBD |
$453.30
|
| Rate for Payer: UMR Bronson Commercial |
$266.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.64
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$949.83
|
|
|
Service Code
|
NDC 54092017212
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.44 |
| Max. Negotiated Rate |
$854.85 |
| Rate for Payer: Aetna American Axle |
$617.39
|
| Rate for Payer: Aetna Commercial |
$807.36
|
| Rate for Payer: Aetna Medicare |
$474.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.39
|
| Rate for Payer: BCBS Complete |
$379.93
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cofinity Commercial |
$664.88
|
| Rate for Payer: Cofinity Commercial |
$816.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$664.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.86
|
| Rate for Payer: Healthscope Commercial |
$854.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$664.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.36
|
| Rate for Payer: PHP Commercial |
$807.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.39
|
| Rate for Payer: Priority Health SBD |
$598.39
|
| Rate for Payer: UMR Bronson Commercial |
$351.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.37
|
|
