|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: BCBS MAPPO |
$5.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.15
|
| Rate for Payer: BCN Commercial |
$16.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.21
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.21
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: PACE Senior Care Partners |
$4.95
|
| Rate for Payer: PACE SWMI |
$5.21
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: PHP Medicare Advantage |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.56
|
| Rate for Payer: Priority Health HMO/PPO |
$18.15
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$17.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.21
|
| Rate for Payer: UHC Exchange |
$5.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.21
|
| Rate for Payer: VA VA |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: BCBS Trust/PPO |
$17.03
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.56
|
| Rate for Payer: Priority Health HMO/PPO |
$18.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$17.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLONAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 09900000354
|
| Hospital Charge Code |
158588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna Commercial |
$0.55
|
| Rate for Payer: Aetna Medicare |
$0.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: BCBS MAPPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.53
|
| Rate for Payer: BCN Commercial |
$0.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.16
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cofinity Commercial |
$0.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.16
|
| Rate for Payer: Healthscope Commercial |
$0.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.55
|
| Rate for Payer: Nomi Health Commercial |
$0.53
|
| Rate for Payer: PACE Senior Care Partners |
$0.15
|
| Rate for Payer: PACE SWMI |
$0.16
|
| Rate for Payer: PHP Commercial |
$0.55
|
| Rate for Payer: PHP Medicare Advantage |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.42
|
| Rate for Payer: Priority Health HMO/PPO |
$0.57
|
| Rate for Payer: Priority Health Medicare |
$0.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.16
|
| Rate for Payer: UHC Exchange |
$0.16
|
| Rate for Payer: UHC Medicare Advantage |
$0.16
|
| Rate for Payer: VA VA |
$0.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.49
|
|
|
CLONAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 09900000354
|
| Hospital Charge Code |
158588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna Commercial |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.53
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cofinity Commercial |
$0.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$0.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.55
|
| Rate for Payer: Nomi Health Commercial |
$0.53
|
| Rate for Payer: PHP Commercial |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.42
|
| Rate for Payer: Priority Health HMO/PPO |
$0.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.49
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$194.12
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.18 |
| Max. Negotiated Rate |
$174.71 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: BCBS Trust/PPO |
$158.46
|
| Rate for Payer: BCN Commercial |
$150.02
|
| Rate for Payer: Cash Price |
$155.30
|
| Rate for Payer: Cofinity Commercial |
$166.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.30
|
| Rate for Payer: Healthscope Commercial |
$174.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.00
|
| Rate for Payer: Nomi Health Commercial |
$159.18
|
| Rate for Payer: PHP Commercial |
$165.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.18
|
| Rate for Payer: Priority Health HMO/PPO |
$168.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$162.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.59
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$250.56
|
|
|
Service Code
|
NDC 57664078486
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.30
|
| Rate for Payer: BCBS Complete |
$100.22
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$205.99
|
| Rate for Payer: BCN Commercial |
$194.81
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Nomi Health Commercial |
$205.46
|
| Rate for Payer: PACE Senior Care Partners |
$59.51
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health HMO/PPO |
$217.99
|
| Rate for Payer: Priority Health Medicare |
$63.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.88
|
| Rate for Payer: Railroad Medicare Medicare |
$62.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.49
|
| Rate for Payer: UHC Core |
$209.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Exchange |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: VA VA |
$62.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.92
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$250.56
|
|
|
Service Code
|
NDC 57664078486
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.86 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: BCBS Trust/PPO |
$204.53
|
| Rate for Payer: BCN Commercial |
$193.63
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Nomi Health Commercial |
$205.46
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health HMO/PPO |
$217.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.49
|
| Rate for Payer: UHC Core |
$209.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.92
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PACE Senior Care Partners |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Medicare |
$0.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.81
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$194.12
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$174.71 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare |
$50.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.66
|
| Rate for Payer: BCBS Complete |
$77.65
|
| Rate for Payer: BCBS MAPPO |
$48.53
|
| Rate for Payer: BCBS Trust/PPO |
$159.59
|
| Rate for Payer: BCN Commercial |
$150.93
|
| Rate for Payer: BCN Medicare Advantage |
$48.53
|
| Rate for Payer: Cash Price |
$155.30
|
| Rate for Payer: Cofinity Commercial |
$166.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$174.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.00
|
| Rate for Payer: Nomi Health Commercial |
$159.18
|
| Rate for Payer: PACE Senior Care Partners |
$46.10
|
| Rate for Payer: PACE SWMI |
$48.53
|
| Rate for Payer: PHP Commercial |
$165.00
|
| Rate for Payer: PHP Medicare Advantage |
$48.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.18
|
| Rate for Payer: Priority Health HMO/PPO |
$168.88
|
| Rate for Payer: Priority Health Medicare |
$49.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.06
|
| Rate for Payer: Railroad Medicare Medicare |
$48.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$162.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.53
|
| Rate for Payer: UHC Exchange |
$48.53
|
| Rate for Payer: UHC Medicare Advantage |
$48.53
|
| Rate for Payer: VA VA |
$48.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.59
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$6.13
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Nomi Health Commercial |
$6.16
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.88
|
| Rate for Payer: Priority Health HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.61
|
| Rate for Payer: UHC Core |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.26 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Aetna Commercial |
$577.15
|
| Rate for Payer: Aetna Medicare |
$176.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.19
|
| Rate for Payer: BCBS Complete |
$271.60
|
| Rate for Payer: BCBS MAPPO |
$169.75
|
| Rate for Payer: BCBS Trust/PPO |
$558.21
|
| Rate for Payer: BCN Commercial |
$527.92
|
| Rate for Payer: BCN Medicare Advantage |
$169.75
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$583.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.75
|
| Rate for Payer: Healthscope Commercial |
$611.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.15
|
| Rate for Payer: Nomi Health Commercial |
$556.78
|
| Rate for Payer: PACE Senior Care Partners |
$161.26
|
| Rate for Payer: PACE SWMI |
$169.75
|
| Rate for Payer: PHP Commercial |
$577.15
|
| Rate for Payer: PHP Medicare Advantage |
$169.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health HMO/PPO |
$590.73
|
| Rate for Payer: Priority Health Medicare |
$171.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$454.93
|
| Rate for Payer: Railroad Medicare Medicare |
$169.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.52
|
| Rate for Payer: UHC Core |
$566.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.75
|
| Rate for Payer: UHC Exchange |
$169.75
|
| Rate for Payer: UHC Medicare Advantage |
$169.75
|
| Rate for Payer: VA VA |
$169.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.99 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Aetna Commercial |
$638.14
|
| Rate for Payer: BCBS Trust/PPO |
$612.84
|
| Rate for Payer: BCN Commercial |
$580.18
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cofinity Commercial |
$645.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.60
|
| Rate for Payer: Healthscope Commercial |
$675.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: Nomi Health Commercial |
$615.62
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.99
|
| Rate for Payer: Priority Health HMO/PPO |
$653.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.66
|
| Rate for Payer: UHC Core |
$626.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$35.71
|
| Rate for Payer: BCN Commercial |
$33.81
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: Nomi Health Commercial |
$35.88
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health HMO/PPO |
$38.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.50
|
| Rate for Payer: UHC Core |
$36.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$441.35 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Aetna Commercial |
$577.15
|
| Rate for Payer: BCBS Trust/PPO |
$554.27
|
| Rate for Payer: BCN Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$583.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.20
|
| Rate for Payer: Healthscope Commercial |
$611.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.15
|
| Rate for Payer: Nomi Health Commercial |
$556.78
|
| Rate for Payer: PHP Commercial |
$577.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health HMO/PPO |
$590.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$454.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.52
|
| Rate for Payer: UHC Core |
$566.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.35
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.84
|
| Rate for Payer: BCN Medicare Advantage |
$1.88
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Nomi Health Commercial |
$6.16
|
| Rate for Payer: PACE Senior Care Partners |
$1.78
|
| Rate for Payer: PACE SWMI |
$1.88
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.88
|
| Rate for Payer: Priority Health HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Medicare |
$1.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.61
|
| Rate for Payer: UHC Core |
$6.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.88
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
| Rate for Payer: VA VA |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.30 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Aetna Commercial |
$638.14
|
| Rate for Payer: Aetna Medicare |
$195.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.61
|
| Rate for Payer: BCBS Complete |
$300.30
|
| Rate for Payer: BCBS MAPPO |
$187.69
|
| Rate for Payer: BCBS Trust/PPO |
$617.19
|
| Rate for Payer: BCN Commercial |
$583.71
|
| Rate for Payer: BCN Medicare Advantage |
$187.69
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cofinity Commercial |
$645.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.69
|
| Rate for Payer: Healthscope Commercial |
$675.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: Nomi Health Commercial |
$615.62
|
| Rate for Payer: PACE Senior Care Partners |
$178.30
|
| Rate for Payer: PACE SWMI |
$187.69
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: PHP Medicare Advantage |
$187.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.99
|
| Rate for Payer: Priority Health HMO/PPO |
$653.15
|
| Rate for Payer: Priority Health Medicare |
$189.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.00
|
| Rate for Payer: Railroad Medicare Medicare |
$187.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.66
|
| Rate for Payer: UHC Core |
$626.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.69
|
| Rate for Payer: UHC Exchange |
$187.69
|
| Rate for Payer: UHC Medicare Advantage |
$187.69
|
| Rate for Payer: VA VA |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$43.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.67
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$35.97
|
| Rate for Payer: BCN Commercial |
$34.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: Nomi Health Commercial |
$35.88
|
| Rate for Payer: PACE Senior Care Partners |
$10.39
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health HMO/PPO |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$11.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.31
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.50
|
| Rate for Payer: UHC Core |
$36.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.94
|
| Rate for Payer: UHC Exchange |
$10.94
|
| Rate for Payer: UHC Medicare Advantage |
$10.94
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$53.23
|
| Rate for Payer: BCN Commercial |
$50.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: PACE Senior Care Partners |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Medicare |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.19
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: VA VA |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: BCBS Trust/PPO |
$52.86
|
| Rate for Payer: BCN Commercial |
$50.04
|
| Rate for Payer: Cash Price |
$51.80
|
| 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: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$493.68 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: BCBS Trust/PPO |
$619.98
|
| Rate for Payer: BCN Commercial |
$586.94
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Nomi Health Commercial |
$622.79
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$508.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.36
|
| Rate for Payer: UHC Core |
$634.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.38 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna Medicare |
$197.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.34
|
| Rate for Payer: BCBS Complete |
$303.80
|
| Rate for Payer: BCBS MAPPO |
$189.88
|
| Rate for Payer: BCBS Trust/PPO |
$624.38
|
| Rate for Payer: BCN Commercial |
$590.51
|
| Rate for Payer: BCN Medicare Advantage |
$189.88
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.88
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Nomi Health Commercial |
$622.79
|
| Rate for Payer: PACE Senior Care Partners |
$180.38
|
| Rate for Payer: PACE SWMI |
$189.88
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: PHP Medicare Advantage |
$189.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Medicare |
$191.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$508.87
|
| Rate for Payer: Railroad Medicare Medicare |
$189.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.36
|
| Rate for Payer: UHC Core |
$634.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.88
|
| Rate for Payer: UHC Exchange |
$189.88
|
| Rate for Payer: UHC Medicare Advantage |
$189.88
|
| Rate for Payer: VA VA |
$189.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.38
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.25
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: BCN Medicare Advantage |
$1.90
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.80
|
| Rate for Payer: PACE SWMI |
$1.90
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$56.76
|
|
|
Service Code
|
NDC 00555100901
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.25
|
| Rate for Payer: Aetna Medicare |
$14.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.74
|
| Rate for Payer: BCBS Complete |
$22.70
|
| Rate for Payer: BCBS MAPPO |
$14.19
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$44.13
|
| Rate for Payer: BCN Medicare Advantage |
$14.19
|
| Rate for Payer: Cash Price |
$45.41
|
| Rate for Payer: Cofinity Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.25
|
| Rate for Payer: Nomi Health Commercial |
$46.54
|
| Rate for Payer: PACE Senior Care Partners |
$13.48
|
| Rate for Payer: PACE SWMI |
$14.19
|
| Rate for Payer: PHP Commercial |
$48.25
|
| Rate for Payer: PHP Medicare Advantage |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.89
|
| Rate for Payer: Priority Health HMO/PPO |
$49.38
|
| Rate for Payer: Priority Health Medicare |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.03
|
| Rate for Payer: Railroad Medicare Medicare |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.95
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.19
|
| Rate for Payer: UHC Exchange |
$14.19
|
| Rate for Payer: UHC Medicare Advantage |
$14.19
|
| Rate for Payer: VA VA |
$14.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.57
|
|
