|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna Medicare |
$32.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Advantage |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.09
|
| Rate for Payer: UHC Core |
$33.73
|
| Rate for Payer: UHC Exchange |
$25.45
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.15
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.88
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.64
|
| Rate for Payer: PHP Commercial |
$4.12
|
| Rate for Payer: Priority Health SBD |
$3.06
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.15
|
| Rate for Payer: BCBS Complete |
$1.94
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.88
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.64
|
| Rate for Payer: PHP Commercial |
$4.12
|
| Rate for Payer: Priority Health SBD |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.15
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Exchange |
$1.91
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$484.75
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.51 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna Medicare |
$242.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.09
|
| Rate for Payer: UHC Core |
$252.55
|
| Rate for Payer: UHC Exchange |
$190.51
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: BCBS Complete |
$21.70
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$28.26
|
| Rate for Payer: UHC Exchange |
$21.32
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 51991070401
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 51079078820
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Advantage |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.79 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Advantage |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health SBD |
$40.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 51079078801
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cofinity Advantage |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.41
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$484.75
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.39 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.43 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Advantage |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.56
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health SBD |
$58.43
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Advantage |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.70
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health SBD |
$0.59
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.05 |
| Max. Negotiated Rate |
$600.08 |
| Rate for Payer: Aetna Commercial |
$566.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.39
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Advantage |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$600.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: PHP Commercial |
$566.74
|
| Rate for Payer: Priority Health SBD |
$420.05
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Advantage |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.56
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.29
|
| Rate for Payer: UHC Core |
$48.32
|
| Rate for Payer: UHC Exchange |
$36.45
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Advantage |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.70
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.60
|
| Rate for Payer: UHC Core |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.37
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 51991070501
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health SBD |
$43.00
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Advantage |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.67
|
| Rate for Payer: Priority Health SBD |
$4.20
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
NDC 00781107701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: BCBS Complete |
$21.70
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$28.26
|
| Rate for Payer: UHC Exchange |
$21.32
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.03 |
| Max. Negotiated Rate |
$600.08 |
| Rate for Payer: Aetna Commercial |
$566.74
|
| Rate for Payer: Aetna Medicare |
$333.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.39
|
| Rate for Payer: BCBS Complete |
$266.70
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Advantage |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$600.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$533.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: PHP Commercial |
$566.74
|
| Rate for Payer: Priority Health SBD |
$420.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.39
|
| Rate for Payer: UHC Core |
$347.38
|
| Rate for Payer: UHC Exchange |
$262.03
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 00781107701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 51991070501
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$34.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health SBD |
$43.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.36
|
| Rate for Payer: UHC Core |
$35.56
|
| Rate for Payer: UHC Exchange |
$26.82
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: Aetna Medicare |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Advantage |
$4.67
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.67
|
| Rate for Payer: Priority Health SBD |
$4.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Exchange |
$2.62
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,166.68 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
|
