|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$2.49
|
|
|
Service Code
|
NDC 60687071111
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cofinity Advantage |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.99
|
| Rate for Payer: Healthscope Commercial |
$2.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.87
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.87
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 60687071111
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cofinity Advantage |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.99
|
| Rate for Payer: Healthscope Commercial |
$2.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.87
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.62
|
| Rate for Payer: UHC Core |
$1.30
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.87
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$233.23
|
|
|
Service Code
|
NDC 50268067915
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.30 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna American Axle |
$151.60
|
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna Medicare |
$116.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.60
|
| Rate for Payer: BCBS Complete |
$93.29
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Advantage |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.92
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: Priority Health SBD |
$146.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.60
|
| Rate for Payer: UHC Core |
$121.51
|
| Rate for Payer: UHC Exchange |
$91.66
|
| Rate for Payer: UMR Bronson Commercial |
$86.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.92
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.43
|
| Rate for Payer: UHC Core |
$175.08
|
| Rate for Payer: UHC Exchange |
$132.07
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$233.23
|
|
|
Service Code
|
NDC 50268067915
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.62 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna American Axle |
$151.60
|
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.60
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Advantage |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.92
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: Priority Health SBD |
$146.93
|
| Rate for Payer: UMR Bronson Commercial |
$102.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.92
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
NDC 60687071101
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna American Axle |
$161.30
|
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna Medicare |
$124.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.30
|
| Rate for Payer: BCBS Complete |
$99.26
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$129.29
|
| Rate for Payer: UHC Exchange |
$97.53
|
| Rate for Payer: UMR Bronson Commercial |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 50268067911
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.97
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
NDC 60687071101
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.19 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna American Axle |
$161.30
|
| Rate for Payer: Aetna Commercial |
$210.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.30
|
| Rate for Payer: Cash Price |
$198.53
|
| Rate for Payer: Cofinity Advantage |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.53
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.12
|
| Rate for Payer: PHP Commercial |
$210.94
|
| Rate for Payer: Priority Health SBD |
$156.34
|
| Rate for Payer: UMR Bronson Commercial |
$109.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.12
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 50268067911
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Advantage |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.97
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
NDC 65162064978
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna American Axle |
$479.70
|
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.70
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cofinity Advantage |
$516.60
|
| Rate for Payer: Cofinity Commercial |
$634.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.40
|
| Rate for Payer: Healthscope Commercial |
$664.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.50
|
| Rate for Payer: PHP Commercial |
$627.30
|
| Rate for Payer: Priority Health SBD |
$464.94
|
| Rate for Payer: UMR Bronson Commercial |
$324.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.50
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
NDC 00054019959
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.84 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Aetna American Axle |
$475.80
|
| Rate for Payer: Aetna Commercial |
$622.20
|
| Rate for Payer: Aetna Medicare |
$366.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.80
|
| Rate for Payer: BCBS Complete |
$292.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Advantage |
$512.40
|
| Rate for Payer: Cofinity Commercial |
$629.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.60
|
| Rate for Payer: Healthscope Commercial |
$658.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$585.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$622.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.00
|
| Rate for Payer: PHP Commercial |
$622.20
|
| Rate for Payer: Priority Health SBD |
$461.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.80
|
| Rate for Payer: UHC Core |
$381.37
|
| Rate for Payer: UHC Exchange |
$287.68
|
| Rate for Payer: UMR Bronson Commercial |
$270.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.00
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,252.40
|
|
|
Service Code
|
NDC 00078035752
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$833.39 |
| Max. Negotiated Rate |
$2,027.16 |
| Rate for Payer: Aetna American Axle |
$1,464.06
|
| Rate for Payer: Aetna Commercial |
$1,914.54
|
| Rate for Payer: Aetna Medicare |
$1,126.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.06
|
| Rate for Payer: BCBS Complete |
$900.96
|
| Rate for Payer: Cash Price |
$1,801.92
|
| Rate for Payer: Cofinity Advantage |
$1,576.68
|
| Rate for Payer: Cofinity Commercial |
$1,937.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,801.92
|
| Rate for Payer: Healthscope Commercial |
$2,027.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,576.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,689.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,801.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,914.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.30
|
| Rate for Payer: PHP Commercial |
$1,914.54
|
| Rate for Payer: Priority Health SBD |
$1,419.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,464.06
|
| Rate for Payer: UHC Core |
$1,173.50
|
| Rate for Payer: UHC Exchange |
$885.19
|
| Rate for Payer: UMR Bronson Commercial |
$833.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,689.30
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$742.80
|
|
|
Service Code
|
NDC 00781627043
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.83 |
| Max. Negotiated Rate |
$668.52 |
| Rate for Payer: Aetna American Axle |
$482.82
|
| Rate for Payer: Aetna Commercial |
$631.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.82
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cofinity Advantage |
$519.96
|
| Rate for Payer: Cofinity Commercial |
$638.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.24
|
| Rate for Payer: Healthscope Commercial |
$668.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$519.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.10
|
| Rate for Payer: PHP Commercial |
$631.38
|
| Rate for Payer: Priority Health SBD |
$467.96
|
| Rate for Payer: UMR Bronson Commercial |
$326.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.10
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,252.40
|
|
|
Service Code
|
NDC 00078035752
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$991.06 |
| Max. Negotiated Rate |
$2,027.16 |
| Rate for Payer: Aetna American Axle |
$1,464.06
|
| Rate for Payer: Aetna Commercial |
$1,914.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.06
|
| Rate for Payer: Cash Price |
$1,801.92
|
| Rate for Payer: Cofinity Advantage |
$1,576.68
|
| Rate for Payer: Cofinity Commercial |
$1,937.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,801.92
|
| Rate for Payer: Healthscope Commercial |
$2,027.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,576.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,689.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,914.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.30
|
| Rate for Payer: PHP Commercial |
$1,914.54
|
| Rate for Payer: Priority Health SBD |
$1,419.01
|
| Rate for Payer: UMR Bronson Commercial |
$991.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,689.30
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$742.80
|
|
|
Service Code
|
NDC 00781627043
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.84 |
| Max. Negotiated Rate |
$668.52 |
| Rate for Payer: Aetna American Axle |
$482.82
|
| Rate for Payer: Aetna Commercial |
$631.38
|
| Rate for Payer: Aetna Medicare |
$371.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.82
|
| Rate for Payer: BCBS Complete |
$297.12
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cofinity Advantage |
$519.96
|
| Rate for Payer: Cofinity Commercial |
$638.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.24
|
| Rate for Payer: Healthscope Commercial |
$668.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$519.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$594.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.10
|
| Rate for Payer: PHP Commercial |
$631.38
|
| Rate for Payer: Priority Health SBD |
$467.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.82
|
| Rate for Payer: UHC Core |
$387.00
|
| Rate for Payer: UHC Exchange |
$291.92
|
| Rate for Payer: UMR Bronson Commercial |
$274.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.10
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
NDC 65162064978
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$664.20 |
| Rate for Payer: Aetna American Axle |
$479.70
|
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna Medicare |
$369.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.70
|
| Rate for Payer: BCBS Complete |
$295.20
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cofinity Advantage |
$516.60
|
| Rate for Payer: Cofinity Commercial |
$634.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.40
|
| Rate for Payer: Healthscope Commercial |
$664.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$590.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.50
|
| Rate for Payer: PHP Commercial |
$627.30
|
| Rate for Payer: Priority Health SBD |
$464.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.70
|
| Rate for Payer: UHC Core |
$384.50
|
| Rate for Payer: UHC Exchange |
$290.03
|
| Rate for Payer: UMR Bronson Commercial |
$273.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.50
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
NDC 00054019959
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.08 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Aetna American Axle |
$475.80
|
| Rate for Payer: Aetna Commercial |
$622.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Advantage |
$512.40
|
| Rate for Payer: Cofinity Commercial |
$629.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.60
|
| Rate for Payer: Healthscope Commercial |
$658.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$622.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.00
|
| Rate for Payer: PHP Commercial |
$622.20
|
| Rate for Payer: Priority Health SBD |
$461.16
|
| Rate for Payer: UMR Bronson Commercial |
$322.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.00
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Advantage |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UMR Bronson Commercial |
$187.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$367.20
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna American Axle |
$238.68
|
| Rate for Payer: Aetna Commercial |
$312.12
|
| Rate for Payer: Aetna Medicare |
$183.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.68
|
| Rate for Payer: BCBS Complete |
$146.88
|
| Rate for Payer: Cash Price |
$293.76
|
| Rate for Payer: Cofinity Advantage |
$257.04
|
| Rate for Payer: Cofinity Commercial |
$315.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.76
|
| Rate for Payer: Healthscope Commercial |
$330.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.40
|
| Rate for Payer: PHP Commercial |
$312.12
|
| Rate for Payer: Priority Health SBD |
$231.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.68
|
| Rate for Payer: UHC Core |
$191.31
|
| Rate for Payer: UHC Exchange |
$144.31
|
| Rate for Payer: UMR Bronson Commercial |
$135.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.40
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 62756018488
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.46 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna American Axle |
$163.18
|
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Advantage |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.28
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health SBD |
$158.16
|
| Rate for Payer: UMR Bronson Commercial |
$110.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.37 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna American Axle |
$194.06
|
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Advantage |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health SBD |
$188.09
|
| Rate for Payer: UMR Bronson Commercial |
$131.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
