|
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
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$878.40
|
|
|
Service Code
|
NDC 66993040732
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$790.56 |
| Rate for Payer: Aetna American Axle |
$570.96
|
| Rate for Payer: Aetna Commercial |
$746.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.96
|
| Rate for Payer: Cash Price |
$702.72
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$386.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$658.80
|
|
|
CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$808.71
|
|
|
Service Code
|
NDC 60505280507
|
| Hospital Charge Code |
37567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.83 |
| Max. Negotiated Rate |
$727.84 |
| Rate for Payer: Aetna American Axle |
$525.66
|
| Rate for Payer: Aetna Commercial |
$687.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.66
|
| Rate for Payer: Cash Price |
$646.97
|
| Rate for Payer: Cofinity Advantage |
$566.10
|
| Rate for Payer: Cofinity Commercial |
$695.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.97
|
| Rate for Payer: Healthscope Commercial |
$727.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.53
|
| Rate for Payer: PHP Commercial |
$687.40
|
| Rate for Payer: Priority Health SBD |
$509.49
|
| Rate for Payer: UMR Bronson Commercial |
$355.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.53
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 50742025701
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Aetna American Axle |
$156.23
|
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Medicare |
$120.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.23
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Advantage |
$168.25
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.26
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health SBD |
$151.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.23
|
| Rate for Payer: UHC Core |
$125.22
|
| Rate for Payer: UHC Exchange |
$94.46
|
| Rate for Payer: UMR Bronson Commercial |
$88.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 50742025701
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Aetna American Axle |
$156.23
|
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.23
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Advantage |
$168.25
|
| Rate for Payer: Cofinity Commercial |
$206.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$216.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.26
|
| Rate for Payer: PHP Commercial |
$204.30
|
| Rate for Payer: Priority Health SBD |
$151.42
|
| Rate for Payer: UMR Bronson Commercial |
$105.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.26
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 51672412301
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.73
|
| Rate for Payer: UHC Core |
$207.38
|
| Rate for Payer: UHC Exchange |
$156.43
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$759.84
|
|
|
Service Code
|
NDC 00078051005
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.14 |
| Max. Negotiated Rate |
$683.86 |
| Rate for Payer: Aetna American Axle |
$493.90
|
| Rate for Payer: Aetna Commercial |
$645.86
|
| Rate for Payer: Aetna Medicare |
$379.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.90
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Cofinity Advantage |
$531.89
|
| Rate for Payer: Cofinity Commercial |
$653.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.87
|
| Rate for Payer: Healthscope Commercial |
$683.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.88
|
| Rate for Payer: PHP Commercial |
$645.86
|
| Rate for Payer: Priority Health SBD |
$478.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.90
|
| Rate for Payer: UHC Core |
$395.88
|
| Rate for Payer: UHC Exchange |
$298.62
|
| Rate for Payer: UMR Bronson Commercial |
$281.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.88
|
|
|
CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$759.84
|
|
|
Service Code
|
NDC 00078051005
|
| Hospital Charge Code |
27634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.33 |
| Max. Negotiated Rate |
$683.86 |
| Rate for Payer: Aetna American Axle |
$493.90
|
| Rate for Payer: Aetna Commercial |
$645.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.90
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Cofinity Advantage |
$531.89
|
| Rate for Payer: Cofinity Commercial |
$653.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.87
|
| Rate for Payer: Healthscope Commercial |
$683.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.88
|
| Rate for Payer: PHP Commercial |
$645.86
|
| Rate for Payer: Priority Health SBD |
$478.70
|
| Rate for Payer: UMR Bronson Commercial |
$334.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.88
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$949.83
|
|
|
Service Code
|
NDC 54092017212
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.93 |
| Max. Negotiated Rate |
$854.85 |
| Rate for Payer: Aetna American Axle |
$617.39
|
| Rate for Payer: Aetna Commercial |
$807.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.39
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cofinity Advantage |
$664.88
|
| Rate for Payer: Cofinity Commercial |
$816.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.86
|
| Rate for Payer: Healthscope Commercial |
$854.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$664.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$712.37
|
| Rate for Payer: PHP Commercial |
$807.36
|
| Rate for Payer: Priority Health SBD |
$598.39
|
| Rate for Payer: UMR Bronson Commercial |
$417.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.37
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$895.68
|
|
|
Service Code
|
NDC 66993040832
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$806.11 |
| Rate for Payer: Aetna American Axle |
$582.19
|
| Rate for Payer: Aetna Commercial |
$761.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.19
|
| Rate for Payer: Cash Price |
$716.54
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$761.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.76
|
| Rate for Payer: PHP Commercial |
$761.33
|
| Rate for Payer: Priority Health SBD |
$564.28
|
| Rate for Payer: UMR Bronson Commercial |
$394.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.76
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$949.83
|
|
|
Service Code
|
NDC 54092017212
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.44 |
| Max. Negotiated Rate |
$854.85 |
| Rate for Payer: Aetna American Axle |
$617.39
|
| Rate for Payer: Aetna Commercial |
$807.36
|
| Rate for Payer: Aetna Medicare |
$474.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.39
|
| Rate for Payer: BCBS Complete |
$379.93
|
| Rate for Payer: Cash Price |
$759.86
|
| Rate for Payer: Cofinity Advantage |
$664.88
|
| Rate for Payer: Cofinity Commercial |
$816.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.86
|
| Rate for Payer: Healthscope Commercial |
$854.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$664.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$759.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$712.37
|
| Rate for Payer: PHP Commercial |
$807.36
|
| Rate for Payer: Priority Health SBD |
$598.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.39
|
| Rate for Payer: UHC Core |
$494.86
|
| Rate for Payer: UHC Exchange |
$373.28
|
| Rate for Payer: UMR Bronson Commercial |
$351.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.37
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$804.68
|
|
|
Service Code
|
NDC 60505280607
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.73 |
| Max. Negotiated Rate |
$724.21 |
| Rate for Payer: Aetna American Axle |
$523.04
|
| Rate for Payer: Aetna Commercial |
$683.98
|
| Rate for Payer: Aetna Medicare |
$402.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.04
|
| Rate for Payer: BCBS Complete |
$321.87
|
| Rate for Payer: Cash Price |
$643.74
|
| Rate for Payer: Cofinity Advantage |
$563.28
|
| Rate for Payer: Cofinity Commercial |
$692.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.74
|
| Rate for Payer: Healthscope Commercial |
$724.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$643.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.51
|
| Rate for Payer: PHP Commercial |
$683.98
|
| Rate for Payer: Priority Health SBD |
$506.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.04
|
| Rate for Payer: UHC Core |
$419.24
|
| Rate for Payer: UHC Exchange |
$316.24
|
| Rate for Payer: UMR Bronson Commercial |
$297.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.51
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$259.41
|
|
|
Service Code
|
NDC 00904688504
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$233.47 |
| Rate for Payer: Aetna American Axle |
$168.62
|
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.62
|
| Rate for Payer: Cash Price |
$207.53
|
| Rate for Payer: Cofinity Advantage |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$223.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.53
|
| Rate for Payer: Healthscope Commercial |
$233.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.56
|
| Rate for Payer: PHP Commercial |
$220.50
|
| Rate for Payer: Priority Health SBD |
$163.43
|
| Rate for Payer: UMR Bronson Commercial |
$114.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.56
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$895.68
|
|
|
Service Code
|
NDC 66993040832
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$806.11 |
| Rate for Payer: Aetna American Axle |
$582.19
|
| Rate for Payer: Aetna Commercial |
$761.33
|
| Rate for Payer: Aetna Medicare |
$447.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.19
|
| Rate for Payer: BCBS Complete |
$358.27
|
| Rate for Payer: Cash Price |
$716.54
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$716.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.76
|
| Rate for Payer: PHP Commercial |
$761.33
|
| Rate for Payer: Priority Health SBD |
$564.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.19
|
| Rate for Payer: UHC Core |
$466.65
|
| Rate for Payer: UHC Exchange |
$352.00
|
| Rate for Payer: UMR Bronson Commercial |
$331.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.76
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$804.68
|
|
|
Service Code
|
NDC 60505280607
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.06 |
| Max. Negotiated Rate |
$724.21 |
| Rate for Payer: Aetna American Axle |
$523.04
|
| Rate for Payer: Aetna Commercial |
$683.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.04
|
| Rate for Payer: Cash Price |
$643.74
|
| Rate for Payer: Cofinity Advantage |
$563.28
|
| Rate for Payer: Cofinity Commercial |
$692.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.74
|
| Rate for Payer: Healthscope Commercial |
$724.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.51
|
| Rate for Payer: PHP Commercial |
$683.98
|
| Rate for Payer: Priority Health SBD |
$506.95
|
| Rate for Payer: UMR Bronson Commercial |
$354.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.51
|
|
|
CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$259.41
|
|
|
Service Code
|
NDC 00904688504
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.98 |
| Max. Negotiated Rate |
$233.47 |
| Rate for Payer: Aetna American Axle |
$168.62
|
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$129.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.62
|
| Rate for Payer: BCBS Complete |
$103.76
|
| Rate for Payer: Cash Price |
$207.53
|
| Rate for Payer: Cofinity Advantage |
$181.59
|
| Rate for Payer: Cofinity Commercial |
$223.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.53
|
| Rate for Payer: Healthscope Commercial |
$233.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.56
|
| Rate for Payer: PHP Commercial |
$220.50
|
| Rate for Payer: Priority Health SBD |
$163.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.62
|
| Rate for Payer: UHC Core |
$135.15
|
| Rate for Payer: UHC Exchange |
$101.95
|
| Rate for Payer: UMR Bronson Commercial |
$95.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.56
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$401.76
|
|
|
Service Code
|
NDC 51672412401
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.65 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$200.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: BCBS Complete |
$160.70
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Core |
$209.32
|
| Rate for Payer: UHC Exchange |
$157.89
|
| Rate for Payer: UMR Bronson Commercial |
$148.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$236.55
|
|
|
Service Code
|
NDC 50742025801
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna Medicare |
$118.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: BCBS Complete |
$94.62
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Advantage |
$165.59
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.41
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.76
|
| Rate for Payer: UHC Core |
$123.24
|
| Rate for Payer: UHC Exchange |
$92.96
|
| Rate for Payer: UMR Bronson Commercial |
$87.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 50742025801
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Advantage |
$165.59
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.41
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$357.12
|
|
|
Service Code
|
NDC 16571068101
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Advantage |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.84
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UMR Bronson Commercial |
$157.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$758.40
|
|
|
Service Code
|
NDC 00781598701
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.61 |
| Max. Negotiated Rate |
$682.56 |
| Rate for Payer: Aetna American Axle |
$492.96
|
| Rate for Payer: Aetna Commercial |
$644.64
|
| Rate for Payer: Aetna Medicare |
$379.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.96
|
| Rate for Payer: BCBS Complete |
$303.36
|
| Rate for Payer: Cash Price |
$606.72
|
| Rate for Payer: Cofinity Advantage |
$530.88
|
| Rate for Payer: Cofinity Commercial |
$652.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.72
|
| Rate for Payer: Healthscope Commercial |
$682.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.80
|
| Rate for Payer: PHP Commercial |
$644.64
|
| Rate for Payer: Priority Health SBD |
$477.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.96
|
| Rate for Payer: UHC Core |
$395.13
|
| Rate for Payer: UHC Exchange |
$298.05
|
| Rate for Payer: UMR Bronson Commercial |
$280.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.80
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$758.40
|
|
|
Service Code
|
NDC 00781598701
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.70 |
| Max. Negotiated Rate |
$682.56 |
| Rate for Payer: Aetna American Axle |
$492.96
|
| Rate for Payer: Aetna Commercial |
$644.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.96
|
| Rate for Payer: Cash Price |
$606.72
|
| Rate for Payer: Cofinity Advantage |
$530.88
|
| Rate for Payer: Cofinity Commercial |
$652.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.72
|
| Rate for Payer: Healthscope Commercial |
$682.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$568.80
|
| Rate for Payer: PHP Commercial |
$644.64
|
| Rate for Payer: Priority Health SBD |
$477.79
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.80
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$401.76
|
|
|
Service Code
|
NDC 51672412401
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna American Axle |
$261.14
|
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.14
|
| Rate for Payer: Cash Price |
$321.41
|
| Rate for Payer: Cofinity Advantage |
$281.23
|
| Rate for Payer: Cofinity Commercial |
$345.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.41
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.32
|
| Rate for Payer: PHP Commercial |
$341.50
|
| Rate for Payer: Priority Health SBD |
$253.11
|
| Rate for Payer: UMR Bronson Commercial |
$176.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.32
|
|
|
CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$357.12
|
|
|
Service Code
|
NDC 16571068101
|
| Hospital Charge Code |
27635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Aetna American Axle |
$232.13
|
| Rate for Payer: Aetna Commercial |
$303.55
|
| Rate for Payer: Aetna Medicare |
$178.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.13
|
| Rate for Payer: BCBS Complete |
$142.85
|
| Rate for Payer: Cash Price |
$285.70
|
| Rate for Payer: Cofinity Advantage |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$307.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.70
|
| Rate for Payer: Healthscope Commercial |
$321.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.84
|
| Rate for Payer: PHP Commercial |
$303.55
|
| Rate for Payer: Priority Health SBD |
$224.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.13
|
| Rate for Payer: UHC Core |
$186.06
|
| Rate for Payer: UHC Exchange |
$140.35
|
| Rate for Payer: UMR Bronson Commercial |
$132.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.84
|
|
