|
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 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 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 |
$349.34
|
| 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 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
|
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 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 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: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| 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: 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
|
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
|
$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
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.24 |
| 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 |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| 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
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.02
|
| 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 |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| 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 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$949.83
|
|
|
Service Code
|
NDC 54092017212
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.93 |
| Max. Negotiated Rate |
$854.85 |
| Rate for Payer: Aetna American Axle |
$617.39
|
| Rate for Payer: Aetna Commercial |
$807.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.39
|
| 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 |
$417.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.37
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$895.68
|
|
|
Service Code
|
NDC 66993040832
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$806.11 |
| Rate for Payer: Aetna American Axle |
$582.19
|
| Rate for Payer: Aetna Commercial |
$761.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.19
|
| Rate for Payer: Cash Price |
$716.54
|
| Rate for Payer: Cofinity Commercial |
$626.98
|
| Rate for Payer: Cofinity Commercial |
$770.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.54
|
| Rate for Payer: Healthscope Commercial |
$806.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.33
|
| Rate for Payer: PHP Commercial |
$761.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.19
|
| Rate for Payer: Priority Health SBD |
$564.28
|
| Rate for Payer: UMR Bronson Commercial |
$394.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.76
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$259.41
|
|
|
Service Code
|
NDC 00904688504
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.98 |
| Max. Negotiated Rate |
$233.47 |
| Rate for Payer: Aetna American Axle |
$168.62
|
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$129.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.62
|
| Rate for Payer: BCBS Complete |
$103.76
|
| Rate for Payer: Cash Price |
$207.53
|
| Rate for Payer: Cofinity Commercial |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$223.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.53
|
| Rate for Payer: Healthscope Commercial |
$233.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.50
|
| Rate for Payer: PHP Commercial |
$220.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.62
|
| Rate for Payer: Priority Health SBD |
$163.43
|
| Rate for Payer: UMR Bronson Commercial |
$95.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.56
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$667.01
|
|
|
Service Code
|
NDC 60505280607
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.48 |
| Max. Negotiated Rate |
$600.31 |
| Rate for Payer: PHP Commercial |
$566.96
|
| Rate for Payer: Aetna American Axle |
$433.56
|
| Rate for Payer: Aetna Commercial |
$566.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.56
|
| Rate for Payer: Cash Price |
$533.61
|
| Rate for Payer: Cofinity Commercial |
$466.91
|
| Rate for Payer: Cofinity Commercial |
$573.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.61
|
| Rate for Payer: Healthscope Commercial |
$600.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.56
|
| Rate for Payer: Priority Health SBD |
$420.22
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.26
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$259.41
|
|
|
Service Code
|
NDC 00904688504
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$233.47 |
| Rate for Payer: Aetna American Axle |
$168.62
|
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.62
|
| Rate for Payer: Cash Price |
$207.53
|
| Rate for Payer: Cofinity Commercial |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$223.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.53
|
| Rate for Payer: Healthscope Commercial |
$233.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.50
|
| Rate for Payer: PHP Commercial |
$220.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.62
|
| Rate for Payer: Priority Health SBD |
$163.43
|
| Rate for Payer: UMR Bronson Commercial |
$114.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.56
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$667.01
|
|
|
Service Code
|
NDC 60505280607
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$600.31 |
| Rate for Payer: Aetna American Axle |
$433.56
|
| Rate for Payer: Aetna Commercial |
$566.96
|
| Rate for Payer: Aetna Medicare |
$333.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.56
|
| Rate for Payer: BCBS Complete |
$266.80
|
| Rate for Payer: Cash Price |
$533.61
|
| Rate for Payer: Cofinity Commercial |
$466.91
|
| Rate for Payer: Cofinity Commercial |
$573.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.61
|
| Rate for Payer: Healthscope Commercial |
$600.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.96
|
| Rate for Payer: PHP Commercial |
$566.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.56
|
| Rate for Payer: Priority Health SBD |
$420.22
|
| Rate for Payer: UMR Bronson Commercial |
$246.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.26
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$895.68
|
|
|
Service Code
|
NDC 66993040832
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$806.11 |
| Rate for Payer: Aetna American Axle |
$582.19
|
| Rate for Payer: Aetna Commercial |
$761.33
|
| Rate for Payer: Aetna Medicare |
$447.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.19
|
| Rate for Payer: BCBS Complete |
$358.27
|
| Rate for Payer: Cash Price |
$716.54
|
| Rate for Payer: Cofinity Commercial |
$626.98
|
| Rate for Payer: Cofinity Commercial |
$770.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.54
|
| Rate for Payer: Healthscope Commercial |
$806.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.33
|
| Rate for Payer: PHP Commercial |
$761.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.19
|
| Rate for Payer: Priority Health SBD |
$564.28
|
| Rate for Payer: UMR Bronson Commercial |
$331.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.76
|
|
|
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
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$758.40
|
|
|
Service Code
|
NDC 00781598701
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.70 |
| Max. Negotiated Rate |
$682.56 |
| Rate for Payer: Aetna American Axle |
$492.96
|
| Rate for Payer: Aetna Commercial |
$644.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.96
|
| Rate for Payer: Cash Price |
$606.72
|
| Rate for Payer: Cofinity Commercial |
$530.88
|
| Rate for Payer: Cofinity Commercial |
$652.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.72
|
| Rate for Payer: Healthscope Commercial |
$682.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.64
|
| Rate for Payer: PHP Commercial |
$644.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.96
|
| Rate for Payer: Priority Health SBD |
$477.79
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.80
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$357.12
|
|
|
Service Code
|
NDC 16571068101
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna Medicare |
$178.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: BCBS Complete |
$142.85
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Commercial |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.55
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.13
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UMR Bronson Commercial |
$132.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
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 |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Commercial |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.14
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$357.12
|
|
|
Service Code
|
NDC 16571068101
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Commercial |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.55
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.13
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UMR Bronson Commercial |
$157.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$758.40
|
|
|
Service Code
|
NDC 00781598701
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.61 |
| Max. Negotiated Rate |
$682.56 |
| Rate for Payer: Aetna American Axle |
$492.96
|
| Rate for Payer: Aetna Commercial |
$644.64
|
| Rate for Payer: Aetna Medicare |
$379.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.96
|
| Rate for Payer: BCBS Complete |
$303.36
|
| Rate for Payer: Cash Price |
$606.72
|
| Rate for Payer: Cofinity Commercial |
$530.88
|
| Rate for Payer: Cofinity Commercial |
$652.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.72
|
| Rate for Payer: Healthscope Commercial |
$682.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.64
|
| Rate for Payer: PHP Commercial |
$644.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.96
|
| Rate for Payer: Priority Health SBD |
$477.79
|
| Rate for Payer: UMR Bronson Commercial |
$280.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.80
|
|
