|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$194.98
|
|
|
Service Code
|
NDC 60687-315-21
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$175.48 |
| Rate for Payer: Aetna American Axle |
$126.74
|
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.74
|
| Rate for Payer: Cash Price |
$155.98
|
| Rate for Payer: Cofinity Commercial |
$136.49
|
| Rate for Payer: Cofinity Commercial |
$167.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.98
|
| Rate for Payer: Healthscope Commercial |
$175.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.73
|
| Rate for Payer: PHP Commercial |
$165.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.49
|
| Rate for Payer: Priority Health SBD |
$122.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.24
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
NDC 60687-315-11
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna American Axle |
$4.22
|
| Rate for Payer: Aetna Commercial |
$5.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.22
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cofinity Commercial |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$5.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.52
|
| Rate for Payer: PHP Commercial |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health SBD |
$4.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.88
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$557.28
|
|
|
Service Code
|
NDC 0904-5046-61
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$501.55 |
| Rate for Payer: Aetna American Axle |
$362.23
|
| Rate for Payer: Aetna Commercial |
$473.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.23
|
| Rate for Payer: Cash Price |
$445.82
|
| Rate for Payer: Cofinity Commercial |
$390.10
|
| Rate for Payer: Cofinity Commercial |
$479.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.82
|
| Rate for Payer: Healthscope Commercial |
$501.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$473.69
|
| Rate for Payer: PHP Commercial |
$473.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.10
|
| Rate for Payer: Priority Health SBD |
$351.09
|
| Rate for Payer: UMR Bronson Commercial |
$245.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.96
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 51079-864-20
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.89 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna American Axle |
$386.88
|
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.88
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$505.92
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.64
|
| Rate for Payer: Priority Health SBD |
$374.98
|
| Rate for Payer: UMR Bronson Commercial |
$261.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
CARBACHOL 0.01 % INTRAOCULAR SOLUTION
|
Facility
|
IP
|
$41.89
|
|
|
Service Code
|
NDC 0065-0023-15
|
| Hospital Charge Code |
19704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna American Axle |
$27.23
|
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.23
|
| Rate for Payer: Cash Price |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$36.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.51
|
| Rate for Payer: Healthscope Commercial |
$37.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.61
|
| Rate for Payer: PHP Commercial |
$35.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.32
|
| Rate for Payer: Priority Health SBD |
$26.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.42
|
|
|
CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,089.23
|
|
|
Service Code
|
NDC 51672-4047-9
|
| Hospital Charge Code |
109663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$479.26 |
| Max. Negotiated Rate |
$980.31 |
| Rate for Payer: Aetna American Axle |
$708.00
|
| Rate for Payer: Aetna Commercial |
$925.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.00
|
| Rate for Payer: Cash Price |
$871.38
|
| Rate for Payer: Cofinity Commercial |
$762.46
|
| Rate for Payer: Cofinity Commercial |
$936.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.38
|
| Rate for Payer: Healthscope Commercial |
$980.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$762.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$925.85
|
| Rate for Payer: PHP Commercial |
$925.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$762.46
|
| Rate for Payer: Priority Health SBD |
$686.21
|
| Rate for Payer: UMR Bronson Commercial |
$479.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.92
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$313.50
|
|
|
Service Code
|
NDC 51079-870-20
|
| 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: 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 Multiplan/Beech St/PHCS |
$266.48
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.45
|
| 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
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 0904-3854-61
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.78
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 51079-870-01
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna American Axle |
$2.04
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| 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 Multiplan/Beech St/PHCS |
$2.67
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
NDC 51672-4041-2
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.88 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna American Axle |
$716.30
|
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.30
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$771.40
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$771.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$826.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$936.70
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$771.40
|
| Rate for Payer: Priority Health SBD |
$694.26
|
| Rate for Payer: UMR Bronson Commercial |
$484.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$826.50
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 51672-4041-1
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 0121-1724-30
|
| 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: 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 Multiplan/Beech St/PHCS |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| 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
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 0121-1724-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$7.90
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| 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
|
IP
|
$13.07
|
|
|
Service Code
|
NDC 68094-008-59
|
| 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: 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 Multiplan/Beech St/PHCS |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| 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
|
$9.48
|
|
|
Service Code
|
NDC 0121-1894-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| 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
|
$13.07
|
|
|
Service Code
|
NDC 68094-008-62
|
| 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: 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 Multiplan/Beech St/PHCS |
$11.11
|
| Rate for Payer: PHP Commercial |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| 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
|
$9.48
|
|
|
Service Code
|
NDC 0121-1894-94
|
| 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: 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 Multiplan/Beech St/PHCS |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| 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 TABLET
|
Facility
|
IP
|
$244.32
|
|
|
Service Code
|
NDC 0904-6172-61
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.50 |
| Max. Negotiated Rate |
$219.89 |
| Rate for Payer: Aetna American Axle |
$158.81
|
| Rate for Payer: Aetna Commercial |
$207.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.81
|
| Rate for Payer: Cash Price |
$195.46
|
| Rate for Payer: Cofinity Commercial |
$171.02
|
| Rate for Payer: Cofinity Commercial |
$210.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.46
|
| Rate for Payer: Healthscope Commercial |
$219.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.67
|
| Rate for Payer: PHP Commercial |
$207.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.02
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.24
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
NDC 51079-385-20
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.52 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna American Axle |
$243.05
|
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.83
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.74
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: UMR Bronson Commercial |
$164.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.44
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 75834-221-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$1,006.03
|
|
|
Service Code
|
NDC 0078-0509-05
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$905.43 |
| Rate for Payer: Aetna American Axle |
$653.92
|
| Rate for Payer: Aetna Commercial |
$855.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.92
|
| Rate for Payer: Cash Price |
$804.82
|
| Rate for Payer: Cofinity Commercial |
$704.22
|
| Rate for Payer: Cofinity Commercial |
$865.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.82
|
| Rate for Payer: Healthscope Commercial |
$905.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$704.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$754.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.13
|
| Rate for Payer: PHP Commercial |
$855.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.22
|
| Rate for Payer: Priority Health SBD |
$633.80
|
| Rate for Payer: UMR Bronson Commercial |
$442.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$754.52
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079-385-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$682.56
|
|
|
Service Code
|
NDC 60505-2805-7
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.33 |
| Max. Negotiated Rate |
$614.30 |
| Rate for Payer: Aetna American Axle |
$443.66
|
| Rate for Payer: Aetna Commercial |
$580.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.66
|
| Rate for Payer: Cash Price |
$546.05
|
| Rate for Payer: Cofinity Commercial |
$477.79
|
| Rate for Payer: Cofinity Commercial |
$587.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.05
|
| Rate for Payer: Healthscope Commercial |
$614.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.18
|
| Rate for Payer: PHP Commercial |
$580.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.79
|
| Rate for Payer: Priority Health SBD |
$430.01
|
| Rate for Payer: UMR Bronson Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.92
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$895.68
|
|
|
Service Code
|
NDC 66993-407-32
|
| Hospital Charge Code |
37567
|
|
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: 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 Multiplan/Beech St/PHCS |
$761.33
|
| Rate for Payer: PHP Commercial |
$761.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.98
|
| 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 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 51672-4123-1
|
| 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: 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 Multiplan/Beech St/PHCS |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.64
|
| 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
|
|
