|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 50268067915
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$116.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$162.92
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.29
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 50268067911
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
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 |
$168.02
|
| 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 Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| 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: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$921.50
|
|
|
Service Code
|
NDC 65162064978
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.96 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Aetna American Axle |
$598.98
|
| Rate for Payer: Aetna Commercial |
$783.28
|
| Rate for Payer: Aetna Medicare |
$460.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.98
|
| Rate for Payer: BCBS Complete |
$368.60
|
| Rate for Payer: Cash Price |
$737.20
|
| Rate for Payer: Cofinity Commercial |
$645.05
|
| Rate for Payer: Cofinity Commercial |
$792.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.20
|
| Rate for Payer: Healthscope Commercial |
$829.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.28
|
| Rate for Payer: PHP Commercial |
$783.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.98
|
| Rate for Payer: Priority Health SBD |
$580.54
|
| Rate for Payer: UMR Bronson Commercial |
$340.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.12
|
|
|
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 Commercial |
$512.40
|
| Rate for Payer: Cofinity Commercial |
$629.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.40
|
| 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: PHP Commercial |
$622.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.80
|
| 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/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 Commercial |
$519.96
|
| Rate for Payer: Cofinity Commercial |
$638.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.96
|
| 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: PHP Commercial |
$631.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.82
|
| 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
|
$921.50
|
|
|
Service Code
|
NDC 65162064978
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.46 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Aetna American Axle |
$598.98
|
| Rate for Payer: Aetna Commercial |
$783.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.98
|
| Rate for Payer: Cash Price |
$737.20
|
| Rate for Payer: Cofinity Commercial |
$645.05
|
| Rate for Payer: Cofinity Commercial |
$792.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.20
|
| Rate for Payer: Healthscope Commercial |
$829.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.28
|
| Rate for Payer: PHP Commercial |
$783.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.98
|
| Rate for Payer: Priority Health SBD |
$580.54
|
| Rate for Payer: UMR Bronson Commercial |
$405.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.12
|
|
|
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 Commercial |
$519.96
|
| Rate for Payer: Cofinity Commercial |
$638.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.96
|
| 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: PHP Commercial |
$631.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.82
|
| Rate for Payer: Priority Health SBD |
$467.96
|
| 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
|
$2,132.40
|
|
|
Service Code
|
NDC 00078035752
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$788.99 |
| Max. Negotiated Rate |
$1,919.16 |
| Rate for Payer: Aetna American Axle |
$1,386.06
|
| Rate for Payer: Aetna Commercial |
$1,812.54
|
| Rate for Payer: Aetna Medicare |
$1,066.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.06
|
| Rate for Payer: BCBS Complete |
$852.96
|
| Rate for Payer: Cash Price |
$1,705.92
|
| Rate for Payer: Cofinity Commercial |
$1,492.68
|
| Rate for Payer: Cofinity Commercial |
$1,833.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,492.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,705.92
|
| Rate for Payer: Healthscope Commercial |
$1,919.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,492.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.54
|
| Rate for Payer: PHP Commercial |
$1,812.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.06
|
| Rate for Payer: Priority Health SBD |
$1,343.41
|
| Rate for Payer: UMR Bronson Commercial |
$788.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.30
|
|
|
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 Commercial |
$512.40
|
| Rate for Payer: Cofinity Commercial |
$629.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.40
|
| 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: PHP Commercial |
$622.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.80
|
| Rate for Payer: Priority Health SBD |
$461.16
|
| 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
|
IP
|
$2,132.40
|
|
|
Service Code
|
NDC 00078035752
|
| Hospital Charge Code |
30479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$938.26 |
| Max. Negotiated Rate |
$1,919.16 |
| Rate for Payer: Aetna American Axle |
$1,386.06
|
| Rate for Payer: Aetna Commercial |
$1,812.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.06
|
| Rate for Payer: Cash Price |
$1,705.92
|
| Rate for Payer: Cofinity Commercial |
$1,492.68
|
| Rate for Payer: Cofinity Commercial |
$1,833.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,492.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,705.92
|
| Rate for Payer: Healthscope Commercial |
$1,919.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,492.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.54
|
| Rate for Payer: PHP Commercial |
$1,812.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.06
|
| Rate for Payer: Priority Health SBD |
$1,343.41
|
| Rate for Payer: UMR Bronson Commercial |
$938.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.30
|
|
|
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 Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| 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: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| 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
|
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 Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.73
|
| 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: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| 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 Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.99
|
| 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: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| 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
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$303.36
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna American Axle |
$197.18
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$151.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.18
|
| Rate for Payer: BCBS Complete |
$121.34
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Commercial |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
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 Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| 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: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| 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 Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.73
|
| 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: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health SBD |
$158.16
|
| Rate for Payer: UMR Bronson Commercial |
$92.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.28
|
|
|
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 Commercial |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.99
|
| 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: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: Priority Health SBD |
$188.09
|
| 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
|
$303.36
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna American Axle |
$197.18
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.18
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Commercial |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$133.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
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 Commercial |
$414.62
|
| Rate for Payer: Cofinity Commercial |
$509.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.62
|
| 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: PHP Commercial |
$503.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.01
|
| 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
|
$593.76
|
|
|
Service Code
|
NDC 00904726461
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.69 |
| Max. Negotiated Rate |
$534.38 |
| Rate for Payer: Aetna American Axle |
$385.94
|
| Rate for Payer: Aetna Commercial |
$504.70
|
| Rate for Payer: Aetna Medicare |
$296.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.94
|
| Rate for Payer: BCBS Complete |
$237.50
|
| Rate for Payer: Cash Price |
$475.01
|
| Rate for Payer: Cofinity Commercial |
$415.63
|
| Rate for Payer: Cofinity Commercial |
$510.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$415.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.01
|
| Rate for Payer: Healthscope Commercial |
$534.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.70
|
| Rate for Payer: PHP Commercial |
$504.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.94
|
| Rate for Payer: Priority Health SBD |
$374.07
|
| Rate for Payer: UMR Bronson Commercial |
$219.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.32
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
IP
|
$593.76
|
|
|
Service Code
|
NDC 00904726461
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.25 |
| Max. Negotiated Rate |
$534.38 |
| Rate for Payer: Aetna American Axle |
$385.94
|
| Rate for Payer: Aetna Commercial |
$504.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.94
|
| Rate for Payer: Cash Price |
$475.01
|
| Rate for Payer: Cofinity Commercial |
$415.63
|
| Rate for Payer: Cofinity Commercial |
$510.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$415.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.01
|
| Rate for Payer: Healthscope Commercial |
$534.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.70
|
| Rate for Payer: PHP Commercial |
$504.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.94
|
| Rate for Payer: Priority Health SBD |
$374.07
|
| Rate for Payer: UMR Bronson Commercial |
$261.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.32
|
|
|
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 Commercial |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$5.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.15
|
| 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: PHP Commercial |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.85
|
| 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
|
|
