|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$313.50
|
|
|
Service Code
|
NDC 51079087020
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$266.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.12
|
| Rate for Payer: PHP Commercial |
$266.48
|
| 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
|
$3.14
|
|
|
Service Code
|
NDC 51079087001
|
| 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 Advantage |
$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 |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.67
|
| 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 |
$2.35
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$378.10
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.36 |
| Max. Negotiated Rate |
$340.29 |
| Rate for Payer: Aetna American Axle |
$245.76
|
| Rate for Payer: Aetna Commercial |
$321.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.76
|
| Rate for Payer: Cash Price |
$302.48
|
| Rate for Payer: Cofinity Advantage |
$264.67
|
| Rate for Payer: Cofinity Commercial |
$325.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.48
|
| Rate for Payer: Healthscope Commercial |
$340.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: PHP Commercial |
$321.38
|
| Rate for Payer: Priority Health SBD |
$238.20
|
| Rate for Payer: UMR Bronson Commercial |
$166.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.57
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$378.10
|
|
|
Service Code
|
NDC 00904385461
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.90 |
| Max. Negotiated Rate |
$340.29 |
| Rate for Payer: Aetna American Axle |
$245.76
|
| Rate for Payer: Aetna Commercial |
$321.38
|
| Rate for Payer: Aetna Medicare |
$189.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.76
|
| Rate for Payer: BCBS Complete |
$151.24
|
| Rate for Payer: Cash Price |
$302.48
|
| Rate for Payer: Cofinity Advantage |
$264.67
|
| Rate for Payer: Cofinity Commercial |
$325.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.48
|
| Rate for Payer: Healthscope Commercial |
$340.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: PHP Commercial |
$321.38
|
| Rate for Payer: Priority Health SBD |
$238.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.76
|
| Rate for Payer: UHC Core |
$196.99
|
| Rate for Payer: UHC Exchange |
$148.59
|
| Rate for Payer: UMR Bronson Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.57
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
NDC 51672404102
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$568.48 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Aetna American Axle |
$839.80
|
| Rate for Payer: Aetna Commercial |
$1,098.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.80
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Cofinity Advantage |
$904.40
|
| Rate for Payer: Cofinity Commercial |
$1,111.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,033.60
|
| Rate for Payer: Healthscope Commercial |
$1,162.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$904.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$969.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.00
|
| Rate for Payer: PHP Commercial |
$1,098.20
|
| Rate for Payer: Priority Health SBD |
$813.96
|
| Rate for Payer: UMR Bronson Commercial |
$568.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$969.00
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna American Axle |
$169.19
|
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Advantage |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UMR Bronson Commercial |
$114.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
NDC 51672404102
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.04 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Aetna American Axle |
$839.80
|
| Rate for Payer: Aetna Commercial |
$1,098.20
|
| Rate for Payer: Aetna Medicare |
$646.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.80
|
| Rate for Payer: BCBS Complete |
$516.80
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Cofinity Advantage |
$904.40
|
| Rate for Payer: Cofinity Commercial |
$1,111.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,033.60
|
| Rate for Payer: Healthscope Commercial |
$1,162.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$904.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$969.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,033.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.00
|
| Rate for Payer: PHP Commercial |
$1,098.20
|
| Rate for Payer: Priority Health SBD |
$813.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.80
|
| Rate for Payer: UHC Core |
$673.13
|
| Rate for Payer: UHC Exchange |
$507.76
|
| Rate for Payer: UMR Bronson Commercial |
$478.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$969.00
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna American Axle |
$169.19
|
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Advantage |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.19
|
| Rate for Payer: UHC Core |
$135.62
|
| Rate for Payer: UHC Exchange |
$102.30
|
| Rate for Payer: UMR Bronson Commercial |
$96.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 51079087001
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna American Axle |
$2.04
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Advantage |
$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 |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.04
|
| Rate for Payer: UHC Core |
$1.64
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TABLET
|
Facility
|
OP
|
$313.50
|
|
|
Service Code
|
NDC 51079087020
|
| Hospital Charge Code |
1355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna Medicare |
$156.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: BCBS Complete |
$125.40
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.12
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health SBD |
$197.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.78
|
| Rate for Payer: UHC Core |
$163.33
|
| Rate for Payer: UHC Exchange |
$123.21
|
| Rate for Payer: UMR Bronson Commercial |
$116.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.12
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.48
|
|
|
Service Code
|
NDC 00121189410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.11
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.16
|
| Rate for Payer: UHC Core |
$4.94
|
| Rate for Payer: UHC Exchange |
$3.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.48
|
|
|
Service Code
|
NDC 00121189410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$8.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.11
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.48
|
|
|
Service Code
|
NDC 00121189494
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$8.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.11
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.29
|
|
|
Service Code
|
NDC 00121172410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.97
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.04
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.29
|
|
|
Service Code
|
NDC 00121172430
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.97
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.04
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 00121172430
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.97
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
OP
|
$9.48
|
|
|
Service Code
|
NDC 00121189494
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna American Axle |
$6.16
|
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.16
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.11
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.16
|
| Rate for Payer: UHC Core |
$4.94
|
| Rate for Payer: UHC Exchange |
$3.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.11
|
|
|
CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION
|
Facility
|
IP
|
$9.29
|
|
|
Service Code
|
NDC 00121172410
|
| Hospital Charge Code |
1356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.97
|
| Rate for Payer: PHP Commercial |
$7.90
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$247.68
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.64 |
| Max. Negotiated Rate |
$222.91 |
| Rate for Payer: Aetna American Axle |
$160.99
|
| Rate for Payer: Aetna Commercial |
$210.53
|
| Rate for Payer: Aetna Medicare |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.99
|
| Rate for Payer: BCBS Complete |
$99.07
|
| Rate for Payer: Cash Price |
$198.14
|
| Rate for Payer: Cofinity Advantage |
$173.38
|
| Rate for Payer: Cofinity Commercial |
$213.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.14
|
| Rate for Payer: Healthscope Commercial |
$222.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: PHP Commercial |
$210.53
|
| Rate for Payer: Priority Health SBD |
$156.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.99
|
| Rate for Payer: UHC Core |
$129.04
|
| Rate for Payer: UHC Exchange |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$91.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.76
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 75834022101
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| 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: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$1,094.09
|
|
|
Service Code
|
NDC 00078050905
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.81 |
| Max. Negotiated Rate |
$984.68 |
| Rate for Payer: Aetna American Axle |
$711.16
|
| Rate for Payer: Aetna Commercial |
$929.98
|
| Rate for Payer: Aetna Medicare |
$547.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.16
|
| Rate for Payer: BCBS Complete |
$437.64
|
| Rate for Payer: Cash Price |
$875.27
|
| Rate for Payer: Cofinity Advantage |
$765.86
|
| Rate for Payer: Cofinity Commercial |
$940.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.27
|
| Rate for Payer: Healthscope Commercial |
$984.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$875.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.57
|
| Rate for Payer: PHP Commercial |
$929.98
|
| Rate for Payer: Priority Health SBD |
$689.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.16
|
| Rate for Payer: UHC Core |
$570.02
|
| Rate for Payer: UHC Exchange |
$429.98
|
| Rate for Payer: UMR Bronson Commercial |
$404.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.57
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$1,094.09
|
|
|
Service Code
|
NDC 00078050905
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.40 |
| Max. Negotiated Rate |
$984.68 |
| Rate for Payer: Aetna American Axle |
$711.16
|
| Rate for Payer: Aetna Commercial |
$929.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.16
|
| Rate for Payer: Cash Price |
$875.27
|
| Rate for Payer: Cofinity Advantage |
$765.86
|
| Rate for Payer: Cofinity Commercial |
$940.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.27
|
| Rate for Payer: Healthscope Commercial |
$984.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.57
|
| Rate for Payer: PHP Commercial |
$929.98
|
| Rate for Payer: Priority Health SBD |
$689.28
|
| Rate for Payer: UMR Bronson Commercial |
$481.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.57
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
IP
|
$247.68
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$222.91 |
| Rate for Payer: Aetna American Axle |
$160.99
|
| Rate for Payer: Aetna Commercial |
$210.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.99
|
| Rate for Payer: Cash Price |
$198.14
|
| Rate for Payer: Cofinity Advantage |
$173.38
|
| Rate for Payer: Cofinity Commercial |
$213.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.14
|
| Rate for Payer: Healthscope Commercial |
$222.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.76
|
| Rate for Payer: PHP Commercial |
$210.53
|
| Rate for Payer: Priority Health SBD |
$156.04
|
| Rate for Payer: UMR Bronson Commercial |
$108.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.76
|
|
|
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 Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| 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: MI Amish Medical Board Commercial |
$263.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.85
|
| Rate for Payer: UHC Core |
$171.41
|
| Rate for Payer: UHC Exchange |
$129.30
|
| 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
|
$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 Advantage |
$614.88
|
| Rate for Payer: Cofinity Commercial |
$755.42
|
| 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: MI Amish Medical Board Commercial |
$702.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$658.80
|
| Rate for Payer: PHP Commercial |
$746.64
|
| Rate for Payer: Priority Health SBD |
$553.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.96
|
| Rate for Payer: UHC Core |
$457.65
|
| Rate for Payer: UHC Exchange |
$345.21
|
| Rate for Payer: UMR Bronson Commercial |
$325.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$658.80
|
|
