|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna American Axle |
$507.46
|
| Rate for Payer: Aetna American Axle |
$185.48
|
| Rate for Payer: Aetna American Axle |
$182.02
|
| Rate for Payer: Aetna Commercial |
$663.60
|
| Rate for Payer: Aetna Commercial |
$238.03
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.46
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$240.83
|
| Rate for Payer: Cofinity Commercial |
$199.75
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Cofinity Commercial |
$671.40
|
| Rate for Payer: Cofinity Commercial |
$546.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$252.03
|
| Rate for Payer: Healthscope Commercial |
$702.63
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.56
|
| Rate for Payer: PHP Commercial |
$663.60
|
| Rate for Payer: PHP Commercial |
$238.03
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.49
|
| Rate for Payer: Priority Health SBD |
$176.42
|
| Rate for Payer: Priority Health SBD |
$491.84
|
| Rate for Payer: Priority Health SBD |
$179.78
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$123.21
|
| Rate for Payer: UMR Bronson Commercial |
$125.56
|
| Rate for Payer: UMR Bronson Commercial |
$343.51
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.02
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$429.07
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$386.16 |
| Rate for Payer: Aetna American Axle |
$278.90
|
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna American Axle |
$180.15
|
| Rate for Payer: Aetna American Axle |
$110.06
|
| Rate for Payer: Aetna American Axle |
$156.49
|
| Rate for Payer: Aetna American Axle |
$507.46
|
| Rate for Payer: Aetna American Axle |
$182.02
|
| Rate for Payer: Aetna American Axle |
$378.67
|
| Rate for Payer: Aetna American Axle |
$185.48
|
| Rate for Payer: Aetna American Axle |
$179.76
|
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Commercial |
$238.03
|
| Rate for Payer: Aetna Commercial |
$364.71
|
| Rate for Payer: Aetna Commercial |
$143.93
|
| Rate for Payer: Aetna Commercial |
$235.59
|
| Rate for Payer: Aetna Commercial |
$204.64
|
| Rate for Payer: Aetna Commercial |
$495.18
|
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna Commercial |
$663.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.15
|
| Rate for Payer: BCBS Complete |
$114.14
|
| Rate for Payer: BCBS Complete |
$171.63
|
| Rate for Payer: BCBS Complete |
$112.01
|
| Rate for Payer: BCBS Complete |
$233.03
|
| Rate for Payer: BCBS Complete |
$312.28
|
| Rate for Payer: BCBS Complete |
$67.73
|
| Rate for Payer: BCBS Complete |
$96.30
|
| Rate for Payer: BCBS Complete |
$110.62
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS Complete |
$110.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$221.73
|
| Rate for Payer: Cash Price |
$221.73
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$343.26
|
| Rate for Payer: Cash Price |
$343.26
|
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cash Price |
$624.56
|
| Rate for Payer: Cofinity Commercial |
$369.00
|
| Rate for Payer: Cofinity Commercial |
$300.35
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$671.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$207.04
|
| Rate for Payer: Cofinity Commercial |
$194.01
|
| Rate for Payer: Cofinity Commercial |
$238.36
|
| Rate for Payer: Cofinity Commercial |
$546.49
|
| Rate for Payer: Cofinity Commercial |
$118.53
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Commercial |
$168.52
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$240.83
|
| Rate for Payer: Cofinity Commercial |
$501.01
|
| Rate for Payer: Cofinity Commercial |
$407.80
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Cofinity Commercial |
$193.58
|
| Rate for Payer: Cofinity Commercial |
$199.75
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.06
|
| Rate for Payer: Healthscope Commercial |
$524.31
|
| Rate for Payer: Healthscope Commercial |
$386.16
|
| Rate for Payer: Healthscope Commercial |
$702.63
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Commercial |
$216.68
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$249.44
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$252.03
|
| Rate for Payer: Healthscope Commercial |
$152.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.60
|
| Rate for Payer: PHP Commercial |
$204.64
|
| Rate for Payer: PHP Commercial |
$238.03
|
| Rate for Payer: PHP Commercial |
$495.18
|
| Rate for Payer: PHP Commercial |
$364.71
|
| Rate for Payer: PHP Commercial |
$663.60
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: PHP Commercial |
$143.93
|
| Rate for Payer: PHP Commercial |
$235.59
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.75
|
| Rate for Payer: Priority Health SBD |
$174.23
|
| Rate for Payer: Priority Health SBD |
$179.78
|
| Rate for Payer: Priority Health SBD |
$270.31
|
| Rate for Payer: Priority Health SBD |
$106.68
|
| Rate for Payer: Priority Health SBD |
$151.67
|
| Rate for Payer: Priority Health SBD |
$176.42
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: Priority Health SBD |
$367.02
|
| Rate for Payer: Priority Health SBD |
$174.61
|
| Rate for Payer: Priority Health SBD |
$491.84
|
| Rate for Payer: UMR Bronson Commercial |
$102.32
|
| Rate for Payer: UMR Bronson Commercial |
$105.58
|
| Rate for Payer: UMR Bronson Commercial |
$215.55
|
| Rate for Payer: UMR Bronson Commercial |
$62.65
|
| Rate for Payer: UMR Bronson Commercial |
$288.86
|
| Rate for Payer: UMR Bronson Commercial |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$84.36
|
| Rate for Payer: UMR Bronson Commercial |
$89.08
|
| Rate for Payer: UMR Bronson Commercial |
$103.61
|
| Rate for Payer: UMR Bronson Commercial |
$102.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.00
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$266.91
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$240.22 |
| Rate for Payer: Aetna American Axle |
$173.49
|
| Rate for Payer: Aetna American Axle |
$87.28
|
| Rate for Payer: Aetna American Axle |
$120.06
|
| Rate for Payer: Aetna American Axle |
$89.18
|
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna American Axle |
$136.32
|
| Rate for Payer: Aetna American Axle |
$98.21
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$128.43
|
| Rate for Payer: Aetna Commercial |
$114.14
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$178.26
|
| Rate for Payer: Aetna Commercial |
$116.62
|
| Rate for Payer: Aetna Commercial |
$157.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.32
|
| Rate for Payer: BCBS Complete |
$54.88
|
| Rate for Payer: BCBS Complete |
$83.89
|
| Rate for Payer: BCBS Complete |
$73.88
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$53.71
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$60.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$107.42
|
| Rate for Payer: Cash Price |
$107.42
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$109.76
|
| Rate for Payer: Cash Price |
$109.76
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$120.87
|
| Rate for Payer: Cash Price |
$120.87
|
| Rate for Payer: Cash Price |
$167.78
|
| Rate for Payer: Cash Price |
$147.77
|
| Rate for Payer: Cash Price |
$147.77
|
| Rate for Payer: Cash Price |
$167.78
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cofinity Commercial |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$129.30
|
| Rate for Payer: Cofinity Commercial |
$158.85
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$180.36
|
| Rate for Payer: Cofinity Commercial |
$129.94
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$146.80
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$96.04
|
| Rate for Payer: Cofinity Commercial |
$117.99
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.77
|
| Rate for Payer: Healthscope Commercial |
$135.98
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$188.75
|
| Rate for Payer: Healthscope Commercial |
$120.85
|
| Rate for Payer: Healthscope Commercial |
$123.48
|
| Rate for Payer: Healthscope Commercial |
$166.24
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.43
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$116.62
|
| Rate for Payer: PHP Commercial |
$157.00
|
| Rate for Payer: PHP Commercial |
$114.14
|
| Rate for Payer: PHP Commercial |
$128.43
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$178.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health SBD |
$95.19
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$116.37
|
| Rate for Payer: Priority Health SBD |
$132.12
|
| Rate for Payer: Priority Health SBD |
$86.44
|
| Rate for Payer: Priority Health SBD |
$84.60
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: UMR Bronson Commercial |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$50.76
|
| Rate for Payer: UMR Bronson Commercial |
$77.60
|
| Rate for Payer: UMR Bronson Commercial |
$69.10
|
| Rate for Payer: UMR Bronson Commercial |
$98.76
|
| Rate for Payer: UMR Bronson Commercial |
$55.90
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.29
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.76
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$168.08 |
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.73
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: UMR Bronson Commercial |
$82.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$8.33
|
|
|
Service Code
|
NDC 62584-813-11
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.83
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.83
|
| Rate for Payer: Priority Health SBD |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$832.13
|
|
|
Service Code
|
NDC 62584-813-01
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$366.14 |
| Max. Negotiated Rate |
$748.92 |
| Rate for Payer: Aetna American Axle |
$540.88
|
| Rate for Payer: Aetna Commercial |
$707.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.88
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cofinity Commercial |
$582.49
|
| Rate for Payer: Cofinity Commercial |
$715.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.70
|
| Rate for Payer: Healthscope Commercial |
$748.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$582.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$707.31
|
| Rate for Payer: PHP Commercial |
$707.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.49
|
| Rate for Payer: Priority Health SBD |
$524.24
|
| Rate for Payer: UMR Bronson Commercial |
$366.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.10
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$333.12
|
|
|
Service Code
|
NDC 0228-2069-10
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.57 |
| Max. Negotiated Rate |
$299.81 |
| Rate for Payer: Aetna American Axle |
$216.53
|
| Rate for Payer: Aetna Commercial |
$283.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.53
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cofinity Commercial |
$233.18
|
| Rate for Payer: Cofinity Commercial |
$286.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.50
|
| Rate for Payer: Healthscope Commercial |
$299.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.15
|
| Rate for Payer: PHP Commercial |
$283.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.18
|
| Rate for Payer: Priority Health SBD |
$209.87
|
| Rate for Payer: UMR Bronson Commercial |
$146.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.84
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 68462-137-01
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.52
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$317.25
|
|
|
Service Code
|
NDC 51991-292-01
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.59 |
| Max. Negotiated Rate |
$285.52 |
| Rate for Payer: Aetna American Axle |
$206.21
|
| Rate for Payer: Aetna Commercial |
$269.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.21
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cofinity Commercial |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$222.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.80
|
| Rate for Payer: Healthscope Commercial |
$285.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.66
|
| Rate for Payer: PHP Commercial |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.08
|
| Rate for Payer: Priority Health SBD |
$199.87
|
| Rate for Payer: UMR Bronson Commercial |
$139.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.94
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,071.20
|
|
|
Service Code
|
NDC 0078-0357-52
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$911.33 |
| Max. Negotiated Rate |
$1,864.08 |
| Rate for Payer: Aetna American Axle |
$1,346.28
|
| Rate for Payer: Aetna Commercial |
$1,760.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,346.28
|
| Rate for Payer: Cash Price |
$1,656.96
|
| Rate for Payer: Cofinity Commercial |
$1,449.84
|
| Rate for Payer: Cofinity Commercial |
$1,781.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,656.96
|
| Rate for Payer: Healthscope Commercial |
$1,864.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,449.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,553.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,760.52
|
| Rate for Payer: PHP Commercial |
$1,760.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.84
|
| Rate for Payer: Priority Health SBD |
$1,304.86
|
| Rate for Payer: UMR Bronson Commercial |
$911.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,553.40
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$742.80
|
|
|
Service Code
|
NDC 0781-6270-43
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.83 |
| Max. Negotiated Rate |
$668.52 |
| Rate for Payer: Aetna American Axle |
$482.82
|
| Rate for Payer: Aetna Commercial |
$631.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.82
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cofinity Commercial |
$519.96
|
| Rate for Payer: Cofinity Commercial |
$638.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.24
|
| Rate for Payer: Healthscope Commercial |
$668.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$519.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$631.38
|
| Rate for Payer: PHP Commercial |
$631.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.96
|
| Rate for Payer: Priority Health SBD |
$467.96
|
| Rate for Payer: UMR Bronson Commercial |
$326.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.10
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
NDC 0054-0199-59
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.08 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Aetna American Axle |
$475.80
|
| Rate for Payer: Aetna Commercial |
$622.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$512.40
|
| Rate for Payer: Cofinity Commercial |
$629.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.60
|
| Rate for Payer: Healthscope Commercial |
$658.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.20
|
| Rate for Payer: PHP Commercial |
$622.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
| Rate for Payer: Priority Health SBD |
$461.16
|
| Rate for Payer: UMR Bronson Commercial |
$322.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.00
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
NDC 65162-649-78
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.92 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna American Axle |
$580.45
|
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.05
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.10
|
| Rate for Payer: Priority Health SBD |
$562.59
|
| Rate for Payer: UMR Bronson Commercial |
$392.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.75
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991-293-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084-853-11
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 62756-184-88
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna American Axle |
$163.18
|
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: Priority Health SBD |
$158.16
|
| Rate for Payer: UMR Bronson Commercial |
$110.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084-853-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.37 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna American Axle |
$194.06
|
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.78
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.99
|
| Rate for Payer: Priority Health SBD |
$188.09
|
| Rate for Payer: UMR Bronson Commercial |
$131.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$295.20
|
|
|
Service Code
|
NDC 0904-7263-61
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.89 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$5.93
|
|
|
Service Code
|
NDC 68084-867-11
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna American Axle |
$3.85
|
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cofinity Commercial |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$5.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.04
|
| Rate for Payer: PHP Commercial |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.15
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.45
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$585.60
|
|
|
Service Code
|
NDC 0904-7264-61
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.66 |
| Max. Negotiated Rate |
$527.04 |
| Rate for Payer: Aetna American Axle |
$380.64
|
| Rate for Payer: Aetna Commercial |
$497.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.64
|
| Rate for Payer: Cash Price |
$468.48
|
| Rate for Payer: Cofinity Commercial |
$409.92
|
| Rate for Payer: Cofinity Commercial |
$503.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.48
|
| Rate for Payer: Healthscope Commercial |
$527.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$497.76
|
| Rate for Payer: PHP Commercial |
$497.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.92
|
| Rate for Payer: Priority Health SBD |
$368.93
|
| Rate for Payer: UMR Bronson Commercial |
$257.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.20
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$592.32
|
|
|
Service Code
|
NDC 68084-867-01
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.62 |
| Max. Negotiated Rate |
$533.09 |
| Rate for Payer: Aetna American Axle |
$385.01
|
| Rate for Payer: Aetna Commercial |
$503.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.01
|
| Rate for Payer: Cash Price |
$473.86
|
| Rate for Payer: Cofinity Commercial |
$414.62
|
| Rate for Payer: Cofinity Commercial |
$509.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.86
|
| Rate for Payer: Healthscope Commercial |
$533.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$414.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$503.47
|
| Rate for Payer: PHP Commercial |
$503.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.62
|
| Rate for Payer: Priority Health SBD |
$373.16
|
| Rate for Payer: UMR Bronson Commercial |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.24
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7,902.83
|
|
|
Service Code
|
NDC 17772-123-01
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,477.25 |
| Max. Negotiated Rate |
$7,112.55 |
| Rate for Payer: Aetna American Axle |
$5,136.84
|
| Rate for Payer: Aetna Commercial |
$6,717.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,136.84
|
| Rate for Payer: Cash Price |
$6,322.26
|
| Rate for Payer: Cofinity Commercial |
$5,531.98
|
| Rate for Payer: Cofinity Commercial |
$6,796.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,322.26
|
| Rate for Payer: Healthscope Commercial |
$7,112.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,531.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,927.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,717.41
|
| Rate for Payer: PHP Commercial |
$6,717.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,531.98
|
| Rate for Payer: Priority Health SBD |
$4,978.78
|
| Rate for Payer: UMR Bronson Commercial |
$3,477.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,927.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$266.78
|
|
|
Service Code
|
NDC 54838-510-80
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.38 |
| Max. Negotiated Rate |
$240.10 |
| Rate for Payer: Aetna American Axle |
$173.41
|
| Rate for Payer: Aetna Commercial |
$226.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.41
|
| Rate for Payer: Cash Price |
$213.42
|
| Rate for Payer: Cofinity Commercial |
$186.75
|
| Rate for Payer: Cofinity Commercial |
$229.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.42
|
| Rate for Payer: Healthscope Commercial |
$240.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.76
|
| Rate for Payer: PHP Commercial |
$226.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health SBD |
$168.07
|
| Rate for Payer: UMR Bronson Commercial |
$117.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.08
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$444.62
|
|
|
Service Code
|
NDC 60432-092-16
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.63 |
| Max. Negotiated Rate |
$400.16 |
| Rate for Payer: Aetna American Axle |
$289.00
|
| Rate for Payer: Aetna Commercial |
$377.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.00
|
| Rate for Payer: Cash Price |
$355.70
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Commercial |
$382.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.70
|
| Rate for Payer: Healthscope Commercial |
$400.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.93
|
| Rate for Payer: PHP Commercial |
$377.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.23
|
| Rate for Payer: Priority Health SBD |
$280.11
|
| Rate for Payer: UMR Bronson Commercial |
$195.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.46
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 0832-0038-00
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: Priority Health SBD |
$74.02
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
