Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$11,153.49

Service Code	APR-DRG 2233
Min. Negotiated Rate	$10,084.09
Max. Negotiated Rate	$11,153.49
Rate for Payer: BCBS Complete	$11,153.49
Rate for Payer: Mclaren Medicaid	$10,622.37
Rate for Payer: Meridian Medicaid	$11,153.49
Rate for Payer: PHP Medicaid	$10,084.09
Rate for Payer: Priority Health Choice Medicaid	$10,622.37
Rate for Payer: UHC Medicaid	$10,622.37
Rate for Payer: UHCCP Medicaid	$10,622.37

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$7,580.25

Service Code	APR-DRG 2231
Min. Negotiated Rate	$6,853.46
Max. Negotiated Rate	$7,580.25
Rate for Payer: BCBS Complete	$7,580.25
Rate for Payer: Mclaren Medicaid	$7,219.29
Rate for Payer: Meridian Medicaid	$7,580.25
Rate for Payer: PHP Medicaid	$6,853.46
Rate for Payer: Priority Health Choice Medicaid	$7,219.29
Rate for Payer: UHC Medicaid	$7,219.29
Rate for Payer: UHCCP Medicaid	$7,219.29

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$10,770.39

Service Code	APR-DRG 2232
Min. Negotiated Rate	$9,737.72
Max. Negotiated Rate	$10,770.39
Rate for Payer: BCBS Complete	$10,770.39
Rate for Payer: Mclaren Medicaid	$10,257.52
Rate for Payer: Meridian Medicaid	$10,770.39
Rate for Payer: PHP Medicaid	$9,737.72
Rate for Payer: Priority Health Choice Medicaid	$10,257.52
Rate for Payer: UHC Medicaid	$10,257.52
Rate for Payer: UHCCP Medicaid	$10,257.52

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$19,709.21

Service Code	APR-DRG 2234
Min. Negotiated Rate	$17,819.48
Max. Negotiated Rate	$19,709.21
Rate for Payer: BCBS Complete	$19,709.21
Rate for Payer: Mclaren Medicaid	$18,770.67
Rate for Payer: Meridian Medicaid	$19,709.21
Rate for Payer: PHP Medicaid	$17,819.48
Rate for Payer: Priority Health Choice Medicaid	$18,770.67
Rate for Payer: UHC Medicaid	$18,770.67
Rate for Payer: UHCCP Medicaid	$18,770.67

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$5,179.75

Service Code	APR-DRG 2221
Min. Negotiated Rate	$4,683.11
Max. Negotiated Rate	$5,179.75
Rate for Payer: BCBS Complete	$5,179.75
Rate for Payer: Mclaren Medicaid	$4,933.10
Rate for Payer: Meridian Medicaid	$5,179.75
Rate for Payer: PHP Medicaid	$4,683.11
Rate for Payer: Priority Health Choice Medicaid	$4,933.10
Rate for Payer: UHC Medicaid	$4,933.10
Rate for Payer: UHCCP Medicaid	$4,933.10

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$13,146.92

Service Code	APR-DRG 2223
Min. Negotiated Rate	$11,886.39
Max. Negotiated Rate	$13,146.92
Rate for Payer: BCBS Complete	$13,146.92
Rate for Payer: Mclaren Medicaid	$12,520.88
Rate for Payer: Meridian Medicaid	$13,146.92
Rate for Payer: PHP Medicaid	$11,886.39
Rate for Payer: Priority Health Choice Medicaid	$12,520.88
Rate for Payer: UHC Medicaid	$12,520.88
Rate for Payer: UHCCP Medicaid	$12,520.88

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$8,627.65

Service Code	APR-DRG 2222
Min. Negotiated Rate	$7,800.43
Max. Negotiated Rate	$8,627.65
Rate for Payer: BCBS Complete	$8,627.65
Rate for Payer: Mclaren Medicaid	$8,216.81
Rate for Payer: Meridian Medicaid	$8,627.65
Rate for Payer: PHP Medicaid	$7,800.43
Rate for Payer: Priority Health Choice Medicaid	$8,216.81
Rate for Payer: UHC Medicaid	$8,216.81
Rate for Payer: UHCCP Medicaid	$8,216.81

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$23,670.99

Service Code	APR-DRG 2224
Min. Negotiated Rate	$21,401.41
Max. Negotiated Rate	$23,670.99
Rate for Payer: BCBS Complete	$23,670.99
Rate for Payer: Mclaren Medicaid	$22,543.80
Rate for Payer: Meridian Medicaid	$23,670.99
Rate for Payer: PHP Medicaid	$21,401.41
Rate for Payer: Priority Health Choice Medicaid	$22,543.80
Rate for Payer: UHC Medicaid	$22,543.80
Rate for Payer: UHCCP Medicaid	$22,543.80

OTHER UPPER VASCULAR PROCEDURES

Facility

$15,430.80

Service Code	APR-DRG 1823
Min. Negotiated Rate	$13,951.29
Max. Negotiated Rate	$15,430.80
Rate for Payer: BCBS Complete	$15,430.80
Rate for Payer: Mclaren Medicaid	$14,696.00
Rate for Payer: Meridian Medicaid	$15,430.80
Rate for Payer: PHP Medicaid	$13,951.29
Rate for Payer: Priority Health Choice Medicaid	$14,696.00
Rate for Payer: UHC Medicaid	$14,696.00
Rate for Payer: UHCCP Medicaid	$14,696.00

OTHER UPPER VASCULAR PROCEDURES

Facility

$12,646.65

Service Code	APR-DRG 1822
Min. Negotiated Rate	$11,434.09
Max. Negotiated Rate	$12,646.65
Rate for Payer: BCBS Complete	$12,646.65
Rate for Payer: Mclaren Medicaid	$12,044.43
Rate for Payer: Meridian Medicaid	$12,646.65
Rate for Payer: PHP Medicaid	$11,434.09
Rate for Payer: Priority Health Choice Medicaid	$12,044.43
Rate for Payer: UHC Medicaid	$12,044.43
Rate for Payer: UHCCP Medicaid	$12,044.43

OTHER UPPER VASCULAR PROCEDURES

Facility

$24,651.90

Service Code	APR-DRG 1824
Min. Negotiated Rate	$22,288.27
Max. Negotiated Rate	$24,651.90
Rate for Payer: BCBS Complete	$24,651.90
Rate for Payer: Mclaren Medicaid	$23,478.00
Rate for Payer: Meridian Medicaid	$24,651.90
Rate for Payer: PHP Medicaid	$22,288.27
Rate for Payer: Priority Health Choice Medicaid	$23,478.00
Rate for Payer: UHC Medicaid	$23,478.00
Rate for Payer: UHCCP Medicaid	$23,478.00

OTHER UPPER VASCULAR PROCEDURES

Facility

$10,392.74

Service Code	APR-DRG 1821
Min. Negotiated Rate	$9,396.28
Max. Negotiated Rate	$10,392.74
Rate for Payer: BCBS Complete	$10,392.74
Rate for Payer: Mclaren Medicaid	$9,897.85
Rate for Payer: Meridian Medicaid	$10,392.74
Rate for Payer: PHP Medicaid	$9,396.28
Rate for Payer: Priority Health Choice Medicaid	$9,897.85
Rate for Payer: UHC Medicaid	$9,897.85
Rate for Payer: UHCCP Medicaid	$9,897.85

OTHER VASCULAR PROCEDURES WITH CC

Facility

$35,660.43

Service Code	MSDRG 253
Min. Negotiated Rate	$19,423.71
Max. Negotiated Rate	$35,660.43
Rate for Payer: Aetna Medicare	$20,446.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$25,557.51
Rate for Payer: Amish Plain Church Group Commercial	$25,557.51
Rate for Payer: BCBS MAPPO	$20,446.01
Rate for Payer: BCN Medicare Advantage	$20,446.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,446.01
Rate for Payer: Humana Choice PPO Medicare	$20,446.01
Rate for Payer: Mclaren Medicare	$20,446.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21,468.31
Rate for Payer: MI Amish Medical Board Commercial	$23,512.91
Rate for Payer: Molina Medicare/Medicaid	$22,490.61
Rate for Payer: PACE Medicare	$19,423.71
Rate for Payer: PACE SWMI	$20,446.01
Rate for Payer: PHP Commercial	$22,490.61
Rate for Payer: PHP Medicare Advantage	$20,446.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$35,660.43
Rate for Payer: Priority Health Medicare	$20,446.01
Rate for Payer: Priority Health Narrow Network	$28,528.34
Rate for Payer: Railroad Medicare Medicare	$20,446.01
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$20,446.01
Rate for Payer: UHC Exchange	$31,691.32
Rate for Payer: UHCCP DNSP	$20,446.01
Rate for Payer: VA VA	$20,446.01

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$47,925.06

Service Code	MSDRG 252
Min. Negotiated Rate	$25,530.83
Max. Negotiated Rate	$47,925.06
Rate for Payer: Aetna Medicare	$26,874.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,593.20
Rate for Payer: Amish Plain Church Group Commercial	$33,593.20
Rate for Payer: BCBS MAPPO	$26,874.56
Rate for Payer: BCN Medicare Advantage	$26,874.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,874.56
Rate for Payer: Humana Choice PPO Medicare	$26,874.56
Rate for Payer: Mclaren Medicare	$26,874.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,218.29
Rate for Payer: MI Amish Medical Board Commercial	$30,905.74
Rate for Payer: Molina Medicare/Medicaid	$29,562.02
Rate for Payer: PACE Medicare	$25,530.83
Rate for Payer: PACE SWMI	$26,874.56
Rate for Payer: PHP Commercial	$29,562.02
Rate for Payer: PHP Medicare Advantage	$26,874.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$47,925.06
Rate for Payer: Priority Health Medicare	$26,874.56
Rate for Payer: Priority Health Narrow Network	$38,340.04
Rate for Payer: Railroad Medicare Medicare	$26,874.56
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,874.56
Rate for Payer: UHC Exchange	$41,655.57
Rate for Payer: UHCCP DNSP	$26,874.56
Rate for Payer: VA VA	$26,874.56

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$24,478.42

Service Code	MSDRG 254
Min. Negotiated Rate	$13,855.66
Max. Negotiated Rate	$24,478.42
Rate for Payer: Aetna Medicare	$14,584.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,231.14
Rate for Payer: Amish Plain Church Group Commercial	$18,231.14
Rate for Payer: BCBS MAPPO	$14,584.91
Rate for Payer: BCN Medicare Advantage	$14,584.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,584.91
Rate for Payer: Humana Choice PPO Medicare	$14,584.91
Rate for Payer: Mclaren Medicare	$14,584.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,314.16
Rate for Payer: MI Amish Medical Board Commercial	$16,772.65
Rate for Payer: Molina Medicare/Medicaid	$16,043.40
Rate for Payer: PACE Medicare	$13,855.66
Rate for Payer: PACE SWMI	$14,584.91
Rate for Payer: PHP Commercial	$16,043.40
Rate for Payer: PHP Medicare Advantage	$14,584.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,478.42
Rate for Payer: Priority Health Medicare	$14,584.91
Rate for Payer: Priority Health Narrow Network	$19,582.74
Rate for Payer: Railroad Medicare Medicare	$14,584.91
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,584.91
Rate for Payer: UHC Exchange	$22,606.61
Rate for Payer: UHCCP DNSP	$14,584.91
Rate for Payer: VA VA	$14,584.91

OTITIS MEDIA AND URI WITH MCC

Facility

$16,242.01

Service Code	MSDRG 152
Min. Negotiated Rate	$9,754.38
Max. Negotiated Rate	$16,242.01
Rate for Payer: Aetna Medicare	$10,267.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,834.71
Rate for Payer: Amish Plain Church Group Commercial	$12,834.71
Rate for Payer: BCBS MAPPO	$10,267.77
Rate for Payer: BCN Medicare Advantage	$10,267.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,267.77
Rate for Payer: Humana Choice PPO Medicare	$10,267.77
Rate for Payer: Mclaren Medicare	$10,267.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,781.16
Rate for Payer: MI Amish Medical Board Commercial	$11,807.94
Rate for Payer: Molina Medicare/Medicaid	$11,294.55
Rate for Payer: PACE Medicare	$9,754.38
Rate for Payer: PACE SWMI	$10,267.77
Rate for Payer: PHP Commercial	$11,294.55
Rate for Payer: PHP Medicare Advantage	$10,267.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16,242.01
Rate for Payer: Priority Health Medicare	$10,267.77
Rate for Payer: Priority Health Narrow Network	$12,993.61
Rate for Payer: Railroad Medicare Medicare	$10,267.77
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,267.77
Rate for Payer: UHC Exchange	$15,915.04
Rate for Payer: UHCCP DNSP	$10,267.77
Rate for Payer: VA VA	$10,267.77

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$10,959.17

Service Code	MSDRG 153
Min. Negotiated Rate	$6,716.91
Max. Negotiated Rate	$10,959.17
Rate for Payer: Aetna Medicare	$7,070.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,838.04
Rate for Payer: Amish Plain Church Group Commercial	$8,838.04
Rate for Payer: BCBS MAPPO	$7,070.43
Rate for Payer: BCN Medicare Advantage	$7,070.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,070.43
Rate for Payer: Humana Choice PPO Medicare	$7,070.43
Rate for Payer: Mclaren Medicare	$7,070.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,423.95
Rate for Payer: MI Amish Medical Board Commercial	$8,130.99
Rate for Payer: Molina Medicare/Medicaid	$7,777.47
Rate for Payer: PACE Medicare	$6,716.91
Rate for Payer: PACE SWMI	$7,070.43
Rate for Payer: PHP Commercial	$7,777.47
Rate for Payer: PHP Medicare Advantage	$7,070.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,141.98
Rate for Payer: Priority Health Medicare	$7,070.43
Rate for Payer: Priority Health Narrow Network	$8,113.59
Rate for Payer: Railroad Medicare Medicare	$7,070.43
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,070.43
Rate for Payer: UHC Exchange	$10,959.17
Rate for Payer: UHCCP DNSP	$7,070.43
Rate for Payer: VA VA	$7,070.43

OXCARBAZEPINE 300 MG TABLET

Facility

$2.99

Service Code	NDC 68084085311
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare	$1.10
Rate for Payer: ASR ASR	$2.90
Rate for Payer: BCBS Complete	$1.19
Rate for Payer: BCBS Trust/PPO	$2.46
Rate for Payer: BCN Commercial	$2.46
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Encore Health Key Benefits Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.90
Rate for Payer: Healthscope Whirlpool	$2.99
Rate for Payer: Mclaren Commercial	$2.69
Rate for Payer: MI Amish Medical Board Commercial	$2.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.54
Rate for Payer: Nomi Health Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.62
Rate for Payer: Priority Health Narrow Network	$2.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.63

OXCARBAZEPINE 300 MG TABLET

Facility

$298.56

Service Code	NDC 68084085301
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$110.47
Max. Negotiated Rate	$298.56
Rate for Payer: Aetna Commercial	$268.70
Rate for Payer: Aetna Medicare	$110.47
Rate for Payer: ASR ASR	$289.60
Rate for Payer: BCBS Complete	$119.42
Rate for Payer: BCBS Trust/PPO	$246.16
Rate for Payer: BCN Commercial	$246.16
Rate for Payer: Cash Price	$238.85
Rate for Payer: Cofinity Commercial	$280.65
Rate for Payer: Encore Health Key Benefits Commercial	$238.85
Rate for Payer: Healthscope Commercial	$289.60
Rate for Payer: Healthscope Whirlpool	$298.56
Rate for Payer: Mclaren Commercial	$268.70
Rate for Payer: MI Amish Medical Board Commercial	$238.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.78
Rate for Payer: Nomi Health Commercial	$244.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$223.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$261.60
Rate for Payer: Priority Health Narrow Network	$209.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$262.73

OXCARBAZEPINE 300 MG TABLET

Facility

$2.99

Service Code	NDC 68084085311
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: ASR ASR	$2.90
Rate for Payer: BCBS Trust/PPO	$2.45
Rate for Payer: BCN Commercial	$2.45
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.81
Rate for Payer: Encore Health Key Benefits Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.90
Rate for Payer: Healthscope Whirlpool	$2.99
Rate for Payer: Mclaren Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.54
Rate for Payer: Nomi Health Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.63

OXCARBAZEPINE 300 MG TABLET

Facility

$204.00

Service Code	NDC 50268068015
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: ASR ASR	$197.88
Rate for Payer: BCBS Trust/PPO	$167.52
Rate for Payer: BCN Commercial	$167.52
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$197.88
Rate for Payer: Healthscope Whirlpool	$204.00
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: Nomi Health Commercial	$167.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

OXCARBAZEPINE 300 MG TABLET

Facility

$4.08

Service Code	NDC 50268068011
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.08
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: ASR ASR	$3.96
Rate for Payer: BCBS Trust/PPO	$3.35
Rate for Payer: BCN Commercial	$3.35
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.26
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Healthscope Whirlpool	$4.08
Rate for Payer: Mclaren Commercial	$3.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.47
Rate for Payer: Nomi Health Commercial	$3.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.59

OXCARBAZEPINE 300 MG TABLET

Facility

$4.08

Service Code	NDC 50268068011
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$4.08
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare	$1.51
Rate for Payer: ASR ASR	$3.96
Rate for Payer: BCBS Complete	$1.63
Rate for Payer: BCBS Trust/PPO	$3.36
Rate for Payer: BCN Commercial	$3.36
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.26
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Healthscope Whirlpool	$4.08
Rate for Payer: Mclaren Commercial	$3.67
Rate for Payer: MI Amish Medical Board Commercial	$3.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.47
Rate for Payer: Nomi Health Commercial	$3.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.57
Rate for Payer: Priority Health Narrow Network	$2.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.59

OXCARBAZEPINE 300 MG TABLET

Facility

$204.00

Service Code	NDC 50268068015
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$75.48
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: Aetna Medicare	$75.48
Rate for Payer: ASR ASR	$197.88
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCBS Trust/PPO	$168.20
Rate for Payer: BCN Commercial	$168.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$197.88
Rate for Payer: Healthscope Whirlpool	$204.00
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: MI Amish Medical Board Commercial	$163.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: Nomi Health Commercial	$167.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$178.74
Rate for Payer: Priority Health Narrow Network	$143.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

OXCARBAZEPINE 300 MG TABLET

Facility

$298.56

Service Code	NDC 68084085301
Hospital Charge Code	21061
Hospital Revenue Code	637
Min. Negotiated Rate	$223.92
Max. Negotiated Rate	$298.56
Rate for Payer: Aetna Commercial	$268.70
Rate for Payer: ASR ASR	$289.60
Rate for Payer: BCBS Trust/PPO	$245.18
Rate for Payer: BCN Commercial	$245.18
Rate for Payer: Cash Price	$238.85
Rate for Payer: Cofinity Commercial	$280.65
Rate for Payer: Encore Health Key Benefits Commercial	$238.85
Rate for Payer: Healthscope Commercial	$289.60
Rate for Payer: Healthscope Whirlpool	$298.56
Rate for Payer: Mclaren Commercial	$268.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.78
Rate for Payer: Nomi Health Commercial	$244.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$223.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$262.73

Know your out-of-pocket cost for care.

All Charges