|
CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$680.84
|
|
|
Service Code
|
NDC 60505280707
|
| Hospital Charge Code |
27633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.57 |
| Max. Negotiated Rate |
$612.76 |
| Rate for Payer: Aetna American Axle |
$442.55
|
| Rate for Payer: Aetna Commercial |
$578.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.55
|
| Rate for Payer: Cash Price |
$544.67
|
| Rate for Payer: Cofinity Advantage |
$476.59
|
| Rate for Payer: Cofinity Commercial |
$585.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.67
|
| Rate for Payer: Healthscope Commercial |
$612.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.63
|
| Rate for Payer: PHP Commercial |
$578.71
|
| Rate for Payer: Priority Health SBD |
$428.93
|
| Rate for Payer: UMR Bronson Commercial |
$299.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.63
|
|
|
CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$949.83
|
|
|
Service Code
|
NDC 54092017312
|
| Hospital Charge Code |
27633
|
|
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 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$818.50
|
|
|
Service Code
|
NDC 29033000412
|
| Hospital Charge Code |
27633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.85 |
| Max. Negotiated Rate |
$736.65 |
| Rate for Payer: Aetna American Axle |
$532.02
|
| Rate for Payer: Aetna Commercial |
$695.73
|
| Rate for Payer: Aetna Medicare |
$409.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.02
|
| Rate for Payer: BCBS Complete |
$327.40
|
| Rate for Payer: Cash Price |
$654.80
|
| Rate for Payer: Cofinity Advantage |
$572.95
|
| Rate for Payer: Cofinity Commercial |
$703.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.80
|
| Rate for Payer: Healthscope Commercial |
$736.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$572.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$654.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.88
|
| Rate for Payer: PHP Commercial |
$695.73
|
| Rate for Payer: Priority Health SBD |
$515.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.02
|
| Rate for Payer: UHC Core |
$426.44
|
| Rate for Payer: UHC Exchange |
$321.67
|
| Rate for Payer: UMR Bronson Commercial |
$302.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.88
|
|
|
CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$818.50
|
|
|
Service Code
|
NDC 29033000412
|
| Hospital Charge Code |
27633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.14 |
| Max. Negotiated Rate |
$736.65 |
| Rate for Payer: Aetna American Axle |
$532.02
|
| Rate for Payer: Aetna Commercial |
$695.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.02
|
| Rate for Payer: Cash Price |
$654.80
|
| Rate for Payer: Cofinity Advantage |
$572.95
|
| Rate for Payer: Cofinity Commercial |
$703.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.80
|
| Rate for Payer: Healthscope Commercial |
$736.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$572.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.88
|
| Rate for Payer: PHP Commercial |
$695.73
|
| Rate for Payer: Priority Health SBD |
$515.65
|
| Rate for Payer: UMR Bronson Commercial |
$360.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.88
|
|
|
CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$680.84
|
|
|
Service Code
|
NDC 60505280707
|
| Hospital Charge Code |
27633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.91 |
| Max. Negotiated Rate |
$612.76 |
| Rate for Payer: Aetna American Axle |
$442.55
|
| Rate for Payer: Aetna Commercial |
$578.71
|
| Rate for Payer: Aetna Medicare |
$340.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.55
|
| Rate for Payer: BCBS Complete |
$272.34
|
| Rate for Payer: Cash Price |
$544.67
|
| Rate for Payer: Cofinity Advantage |
$476.59
|
| Rate for Payer: Cofinity Commercial |
$585.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.67
|
| Rate for Payer: Healthscope Commercial |
$612.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$544.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.63
|
| Rate for Payer: PHP Commercial |
$578.71
|
| Rate for Payer: Priority Health SBD |
$428.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.55
|
| Rate for Payer: UHC Core |
$354.72
|
| Rate for Payer: UHC Exchange |
$267.57
|
| Rate for Payer: UMR Bronson Commercial |
$251.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.63
|
|
|
CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$895.68
|
|
|
Service Code
|
NDC 66993040932
|
| Hospital Charge Code |
27633
|
|
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 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
OP
|
$949.83
|
|
|
Service Code
|
NDC 54092017312
|
| Hospital Charge Code |
27633
|
|
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 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR
|
Facility
|
IP
|
$895.68
|
|
|
Service Code
|
NDC 66993040932
|
| Hospital Charge Code |
27633
|
|
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
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna American Axle |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.79
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Advantage |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health SBD |
$14.33
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$9.99
|
|
|
Service Code
|
NDC 00904747835
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna American Axle |
$6.49
|
| Rate for Payer: Aetna Commercial |
$8.49
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.49
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cofinity Advantage |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Healthscope Commercial |
$8.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: PHP Commercial |
$8.49
|
| Rate for Payer: Priority Health SBD |
$6.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.49
|
| Rate for Payer: UHC Core |
$5.20
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.49
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$28.72
|
|
|
Service Code
|
NDC 42037010479
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Medicare |
$14.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$14.96
|
| Rate for Payer: UHC Exchange |
$11.29
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna American Axle |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.79
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Advantage |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health SBD |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.79
|
| Rate for Payer: UHC Core |
$11.85
|
| Rate for Payer: UHC Exchange |
$8.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna American Axle |
$14.54
|
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.54
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Advantage |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.78
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: Priority Health SBD |
$14.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Aetna American Axle |
$6.98
|
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.98
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Advantage |
$7.52
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$9.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.05
|
| Rate for Payer: PHP Commercial |
$9.13
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.05
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$26.13
|
|
|
Service Code
|
NDC 78112073621
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna American Axle |
$16.98
|
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cofinity Advantage |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.90
|
| Rate for Payer: Healthscope Commercial |
$23.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.60
|
| Rate for Payer: PHP Commercial |
$22.21
|
| Rate for Payer: Priority Health SBD |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$10.74
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Aetna American Axle |
$6.98
|
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.98
|
| Rate for Payer: BCBS Complete |
$4.30
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Advantage |
$7.52
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$9.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.05
|
| Rate for Payer: PHP Commercial |
$9.13
|
| Rate for Payer: Priority Health SBD |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.98
|
| Rate for Payer: UHC Core |
$5.60
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.05
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$26.13
|
|
|
Service Code
|
NDC 78112073621
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna American Axle |
$16.98
|
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: BCBS Complete |
$10.45
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cofinity Advantage |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.90
|
| Rate for Payer: Healthscope Commercial |
$23.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.60
|
| Rate for Payer: PHP Commercial |
$22.21
|
| Rate for Payer: Priority Health SBD |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.98
|
| Rate for Payer: UHC Core |
$13.61
|
| Rate for Payer: UHC Exchange |
$10.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
NDC 42037010478
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$20.13 |
| Rate for Payer: Aetna American Axle |
$14.54
|
| Rate for Payer: Aetna Commercial |
$19.01
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.54
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cofinity Advantage |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$20.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.78
|
| Rate for Payer: PHP Commercial |
$19.01
|
| Rate for Payer: Priority Health SBD |
$14.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.54
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Exchange |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.78
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$28.72
|
|
|
Service Code
|
NDC 42037010479
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cofinity Advantage |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.54
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: UMR Bronson Commercial |
$12.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS
|
Facility
|
IP
|
$9.99
|
|
|
Service Code
|
NDC 00904747835
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna American Axle |
$6.49
|
| Rate for Payer: Aetna Commercial |
$8.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.49
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cofinity Advantage |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Healthscope Commercial |
$8.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: PHP Commercial |
$8.49
|
| Rate for Payer: Priority Health SBD |
$6.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.49
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 62756051788
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$120.27
|
| Rate for Payer: UHC Exchange |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00378007801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$120.27
|
| Rate for Payer: UHC Exchange |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: BCBS Complete |
$53.58
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Advantage |
$93.77
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.07
|
| Rate for Payer: UHC Core |
$69.79
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UMR Bronson Commercial |
$49.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Advantage |
$93.77
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UMR Bronson Commercial |
$58.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 69367033801
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
