|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna American Axle |
$194.06
|
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: BCBS Complete |
$119.42
|
| 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: MI Amish Medical Board Commercial |
$238.85
|
| 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: UHC All Payor (Choice/PPO) |
$194.06
|
| Rate for Payer: UHC Core |
$155.55
|
| Rate for Payer: UHC Exchange |
$117.33
|
| Rate for Payer: UMR Bronson Commercial |
$110.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$251.04
|
|
|
Service Code
|
NDC 62756018488
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.88 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna American Axle |
$163.18
|
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna Medicare |
$125.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: BCBS Complete |
$100.42
|
| 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: MI Amish Medical Board Commercial |
$200.83
|
| 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: UHC All Payor (Choice/PPO) |
$163.18
|
| Rate for Payer: UHC Core |
$130.79
|
| Rate for Payer: UHC Exchange |
$98.66
|
| Rate for Payer: UMR Bronson Commercial |
$92.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$367.20
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.57 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna American Axle |
$238.68
|
| Rate for Payer: Aetna Commercial |
$312.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.68
|
| 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: 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: UMR Bronson Commercial |
$161.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.40
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: BCBS Complete |
$170.14
|
| 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: MI Amish Medical Board Commercial |
$340.28
|
| 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: UHC All Payor (Choice/PPO) |
$276.48
|
| Rate for Payer: UHC Core |
$221.61
|
| Rate for Payer: UHC Exchange |
$167.16
|
| Rate for Payer: UMR Bronson Commercial |
$157.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$592.32
|
|
|
Service Code
|
NDC 68084086701
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.16 |
| Max. Negotiated Rate |
$533.09 |
| Rate for Payer: Aetna American Axle |
$385.01
|
| Rate for Payer: Aetna Commercial |
$503.47
|
| Rate for Payer: Aetna Medicare |
$296.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.01
|
| Rate for Payer: BCBS Complete |
$236.93
|
| Rate for Payer: Cash Price |
$473.86
|
| Rate for Payer: Cofinity Advantage |
$414.62
|
| Rate for Payer: Cofinity Commercial |
$509.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.86
|
| Rate for Payer: Healthscope Commercial |
$533.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$414.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$473.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$444.24
|
| Rate for Payer: PHP Commercial |
$503.47
|
| Rate for Payer: Priority Health SBD |
$373.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.01
|
| Rate for Payer: UHC Core |
$308.60
|
| Rate for Payer: UHC Exchange |
$232.78
|
| Rate for Payer: UMR Bronson Commercial |
$219.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.24
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$5.93
|
|
|
Service Code
|
NDC 68084086711
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna American Axle |
$3.85
|
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: BCBS Complete |
$2.37
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cofinity Advantage |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$5.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.45
|
| Rate for Payer: PHP Commercial |
$5.04
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.45
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$610.08
|
|
|
Service Code
|
NDC 00904726461
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.44 |
| Max. Negotiated Rate |
$549.07 |
| Rate for Payer: Aetna American Axle |
$396.55
|
| Rate for Payer: Aetna Commercial |
$518.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.55
|
| Rate for Payer: Cash Price |
$488.06
|
| Rate for Payer: Cofinity Advantage |
$427.06
|
| Rate for Payer: Cofinity Commercial |
$524.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.06
|
| Rate for Payer: Healthscope Commercial |
$549.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.56
|
| Rate for Payer: PHP Commercial |
$518.57
|
| Rate for Payer: Priority Health SBD |
$384.35
|
| Rate for Payer: UMR Bronson Commercial |
$268.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.56
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$610.08
|
|
|
Service Code
|
NDC 00904726461
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.73 |
| Max. Negotiated Rate |
$549.07 |
| Rate for Payer: Aetna American Axle |
$396.55
|
| Rate for Payer: Aetna Commercial |
$518.57
|
| Rate for Payer: Aetna Medicare |
$305.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.55
|
| Rate for Payer: BCBS Complete |
$244.03
|
| Rate for Payer: Cash Price |
$488.06
|
| Rate for Payer: Cofinity Advantage |
$427.06
|
| Rate for Payer: Cofinity Commercial |
$524.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.06
|
| Rate for Payer: Healthscope Commercial |
$549.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$488.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.56
|
| Rate for Payer: PHP Commercial |
$518.57
|
| Rate for Payer: Priority Health SBD |
$384.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.55
|
| Rate for Payer: UHC Core |
$317.85
|
| Rate for Payer: UHC Exchange |
$239.76
|
| Rate for Payer: UMR Bronson Commercial |
$225.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.56
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 51991005501
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Advantage |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UMR Bronson Commercial |
$133.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$5.93
|
|
|
Service Code
|
NDC 68084086711
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna American Axle |
$3.85
|
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cofinity Advantage |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$5.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.45
|
| Rate for Payer: PHP Commercial |
$5.04
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.45
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$592.32
|
|
|
Service Code
|
NDC 68084086701
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.62 |
| Max. Negotiated Rate |
$533.09 |
| Rate for Payer: Aetna American Axle |
$385.01
|
| Rate for Payer: Aetna Commercial |
$503.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.01
|
| Rate for Payer: Cash Price |
$473.86
|
| Rate for Payer: Cofinity Advantage |
$414.62
|
| Rate for Payer: Cofinity Commercial |
$509.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.86
|
| Rate for Payer: Healthscope Commercial |
$533.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$414.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$444.24
|
| Rate for Payer: PHP Commercial |
$503.47
|
| Rate for Payer: Priority Health SBD |
$373.16
|
| Rate for Payer: UMR Bronson Commercial |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.24
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
NDC 51991005501
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna American Axle |
$197.60
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Advantage |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health SBD |
$191.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.60
|
| Rate for Payer: UHC Core |
$158.38
|
| Rate for Payer: UHC Exchange |
$119.47
|
| Rate for Payer: UMR Bronson Commercial |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.00
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$6,076.51
|
|
|
Service Code
|
NDC 27241023901
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,673.66 |
| Max. Negotiated Rate |
$5,468.86 |
| Rate for Payer: Aetna American Axle |
$3,949.73
|
| Rate for Payer: Aetna Commercial |
$5,165.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,949.73
|
| Rate for Payer: Cash Price |
$4,861.21
|
| Rate for Payer: Cofinity Advantage |
$4,253.56
|
| Rate for Payer: Cofinity Commercial |
$5,225.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,861.21
|
| Rate for Payer: Healthscope Commercial |
$5,468.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,253.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,557.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,165.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,557.38
|
| Rate for Payer: PHP Commercial |
$5,165.03
|
| Rate for Payer: Priority Health SBD |
$3,828.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,673.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,557.38
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8,377.17
|
|
|
Service Code
|
NDC 17772012301
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,099.55 |
| Max. Negotiated Rate |
$7,539.45 |
| Rate for Payer: Aetna American Axle |
$5,445.16
|
| Rate for Payer: Aetna Commercial |
$7,120.59
|
| Rate for Payer: Aetna Medicare |
$4,188.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,445.16
|
| Rate for Payer: BCBS Complete |
$3,350.87
|
| Rate for Payer: Cash Price |
$6,701.74
|
| Rate for Payer: Cofinity Advantage |
$5,864.02
|
| Rate for Payer: Cofinity Commercial |
$7,204.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,701.74
|
| Rate for Payer: Healthscope Commercial |
$7,539.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,864.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,282.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,701.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,120.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,282.88
|
| Rate for Payer: PHP Commercial |
$7,120.59
|
| Rate for Payer: Priority Health SBD |
$5,277.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,445.16
|
| Rate for Payer: UHC Core |
$4,364.51
|
| Rate for Payer: UHC Exchange |
$3,292.23
|
| Rate for Payer: UMR Bronson Commercial |
$3,099.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,282.88
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8,377.17
|
|
|
Service Code
|
NDC 17772012301
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,685.95 |
| Max. Negotiated Rate |
$7,539.45 |
| Rate for Payer: Aetna American Axle |
$5,445.16
|
| Rate for Payer: Aetna Commercial |
$7,120.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,445.16
|
| Rate for Payer: Cash Price |
$6,701.74
|
| Rate for Payer: Cofinity Advantage |
$5,864.02
|
| Rate for Payer: Cofinity Commercial |
$7,204.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,701.74
|
| Rate for Payer: Healthscope Commercial |
$7,539.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,864.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,282.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,120.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,282.88
|
| Rate for Payer: PHP Commercial |
$7,120.59
|
| Rate for Payer: Priority Health SBD |
$5,277.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,685.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,282.88
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$6,076.51
|
|
|
Service Code
|
NDC 27241023901
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,248.31 |
| Max. Negotiated Rate |
$5,468.86 |
| Rate for Payer: Aetna American Axle |
$3,949.73
|
| Rate for Payer: Aetna Commercial |
$5,165.03
|
| Rate for Payer: Aetna Medicare |
$3,038.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,949.73
|
| Rate for Payer: BCBS Complete |
$2,430.60
|
| Rate for Payer: Cash Price |
$4,861.21
|
| Rate for Payer: Cofinity Advantage |
$4,253.56
|
| Rate for Payer: Cofinity Commercial |
$5,225.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,861.21
|
| Rate for Payer: Healthscope Commercial |
$5,468.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,253.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,557.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,861.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,165.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,557.38
|
| Rate for Payer: PHP Commercial |
$5,165.03
|
| Rate for Payer: Priority Health SBD |
$3,828.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,949.73
|
| Rate for Payer: UHC Core |
$3,165.86
|
| Rate for Payer: UHC Exchange |
$2,388.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,248.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,557.38
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$366.82
|
|
|
Service Code
|
NDC 54838051080
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.72 |
| Max. Negotiated Rate |
$330.14 |
| Rate for Payer: Aetna American Axle |
$238.43
|
| Rate for Payer: Aetna Commercial |
$311.80
|
| Rate for Payer: Aetna Medicare |
$183.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.43
|
| Rate for Payer: BCBS Complete |
$146.73
|
| Rate for Payer: Cash Price |
$293.46
|
| Rate for Payer: Cofinity Advantage |
$256.77
|
| Rate for Payer: Cofinity Commercial |
$315.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.46
|
| Rate for Payer: Healthscope Commercial |
$330.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.12
|
| Rate for Payer: PHP Commercial |
$311.80
|
| Rate for Payer: Priority Health SBD |
$231.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.43
|
| Rate for Payer: UHC Core |
$191.11
|
| Rate for Payer: UHC Exchange |
$144.16
|
| Rate for Payer: UMR Bronson Commercial |
$135.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$366.82
|
|
|
Service Code
|
NDC 54838051080
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$330.14 |
| Rate for Payer: Aetna American Axle |
$238.43
|
| Rate for Payer: Aetna Commercial |
$311.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.43
|
| Rate for Payer: Cash Price |
$293.46
|
| Rate for Payer: Cofinity Advantage |
$256.77
|
| Rate for Payer: Cofinity Commercial |
$315.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.46
|
| Rate for Payer: Healthscope Commercial |
$330.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.12
|
| Rate for Payer: PHP Commercial |
$311.80
|
| Rate for Payer: Priority Health SBD |
$231.10
|
| Rate for Payer: UMR Bronson Commercial |
$161.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$161.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Advantage |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.33
|
| Rate for Payer: UHC Core |
$167.79
|
| Rate for Payer: UHC Exchange |
$126.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.15 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna Medicare |
$204.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: BCBS Complete |
$163.40
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Advantage |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.52
|
| Rate for Payer: UHC Core |
$212.83
|
| Rate for Payer: UHC Exchange |
$160.54
|
| Rate for Payer: UMR Bronson Commercial |
$151.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 52817026010
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Advantage |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.12
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00832003800
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.61
|
| Rate for Payer: UHC Core |
$138.35
|
| Rate for Payer: UHC Exchange |
$104.36
|
| Rate for Payer: UMR Bronson Commercial |
$98.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.74 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna American Axle |
$265.52
|
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.52
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Advantage |
$285.95
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health SBD |
$257.36
|
| Rate for Payer: UMR Bronson Commercial |
$179.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Advantage |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.66
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Exchange |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
