|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$313.06
|
|
|
Service Code
|
NDC 62332036506
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.19 |
| Max. Negotiated Rate |
$281.75 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: Aetna Medicare |
$81.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.83
|
| Rate for Payer: BCBS Complete |
$57.95
|
| Rate for Payer: BCBS MAPPO |
$78.27
|
| Rate for Payer: BCBS Trust/PPO |
$257.37
|
| Rate for Payer: BCN Commercial |
$257.37
|
| Rate for Payer: BCN Medicare Advantage |
$78.27
|
| Rate for Payer: Cash Price |
$250.45
|
| Rate for Payer: Cofinity Commercial |
$269.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.27
|
| Rate for Payer: Healthscope Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.79
|
| Rate for Payer: Mclaren Medicaid |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.18
|
| Rate for Payer: Meridian Medicaid |
$57.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.10
|
| Rate for Payer: Nomi Health Commercial |
$256.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.79
|
| Rate for Payer: PACE Senior Care Partners |
$74.35
|
| Rate for Payer: PACE SWMI |
$78.27
|
| Rate for Payer: PHP Commercial |
$266.10
|
| Rate for Payer: PHP Medicare Advantage |
$78.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$272.36
|
| Rate for Payer: Priority Health Medicare |
$79.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.89
|
| Rate for Payer: Railroad Medicare Medicare |
$78.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.49
|
| Rate for Payer: UHC Core |
$261.41
|
| Rate for Payer: UHC Exchange |
$78.27
|
| Rate for Payer: UHC Medicaid |
$55.19
|
| Rate for Payer: UHC Medicare Advantage |
$78.27
|
| Rate for Payer: UHCCP Medicaid |
$55.19
|
| Rate for Payer: VA VA |
$78.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.79
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$247.40
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$222.66 |
| Rate for Payer: Aetna Commercial |
$210.29
|
| Rate for Payer: BCBS Trust/PPO |
$204.33
|
| Rate for Payer: BCN Commercial |
$204.33
|
| Rate for Payer: Cash Price |
$197.92
|
| Rate for Payer: Cofinity Commercial |
$212.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$222.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.29
|
| Rate for Payer: Nomi Health Commercial |
$202.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.55
|
| Rate for Payer: PHP Commercial |
$210.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.71
|
| Rate for Payer: UHC Core |
$206.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.55
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Mclaren Medicaid |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: Meridian Medicaid |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PACE Senior Care Partners |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.59
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UHC Medicaid |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: UHCCP Medicaid |
$0.73
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
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 |
$44.17 |
| 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 |
$46.38
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$205.99
|
| Rate for Payer: BCN Commercial |
$205.99
|
| 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: Mclaren Medicaid |
$44.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Meridian Medicaid |
$46.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Nomi Health Commercial |
$205.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.92
|
| 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 Choice Medicaid |
$44.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.99
|
| Rate for Payer: Priority Health Medicare |
$63.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.39
|
| 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 Exchange |
$62.64
|
| Rate for Payer: UHC Medicaid |
$44.17
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: UHCCP Medicaid |
$44.17
|
| 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
|
$313.06
|
|
|
Service Code
|
NDC 62332036506
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.89 |
| Max. Negotiated Rate |
$281.75 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: BCBS Trust/PPO |
$258.56
|
| Rate for Payer: BCN Commercial |
$258.56
|
| Rate for Payer: Cash Price |
$250.45
|
| Rate for Payer: Cofinity Commercial |
$269.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.45
|
| Rate for Payer: Healthscope Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.10
|
| Rate for Payer: Nomi Health Commercial |
$256.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.79
|
| Rate for Payer: PHP Commercial |
$266.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$272.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.49
|
| Rate for Payer: UHC Core |
$261.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.79
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$29.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.30
|
| Rate for Payer: BCBS Complete |
$5.51
|
| Rate for Payer: BCBS MAPPO |
$7.44
|
| Rate for Payer: BCBS Trust/PPO |
$24.46
|
| Rate for Payer: BCN Commercial |
$24.46
|
| Rate for Payer: BCN Medicare Advantage |
$7.44
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$26.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.31
|
| Rate for Payer: Mclaren Medicaid |
$5.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.81
|
| Rate for Payer: Meridian Medicaid |
$5.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.29
|
| Rate for Payer: Nomi Health Commercial |
$24.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.31
|
| Rate for Payer: PACE Senior Care Partners |
$7.07
|
| Rate for Payer: PACE SWMI |
$7.44
|
| Rate for Payer: PHP Commercial |
$25.29
|
| Rate for Payer: PHP Medicare Advantage |
$7.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.88
|
| Rate for Payer: Priority Health Medicare |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.18
|
| Rate for Payer: UHC Core |
$24.84
|
| Rate for Payer: UHC Exchange |
$7.44
|
| Rate for Payer: UHC Medicaid |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.44
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: VA VA |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.31
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$467.71 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$571.20
|
| Rate for Payer: BCBS Trust/PPO |
$555.00
|
| Rate for Payer: BCN Commercial |
$555.00
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.60
|
| Rate for Payer: Healthscope Commercial |
$604.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.20
|
| Rate for Payer: Nomi Health Commercial |
$551.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.00
|
| Rate for Payer: PHP Commercial |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$584.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$467.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.36
|
| Rate for Payer: UHC Core |
$561.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.00
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| 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 |
$1.39
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| 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: Mclaren Medicaid |
$1.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: Meridian Medicaid |
$1.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Nomi Health Commercial |
$6.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.63
|
| 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 Choice Medicaid |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Medicare |
$1.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.23
|
| 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 Exchange |
$1.88
|
| Rate for Payer: UHC Medicaid |
$1.32
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
| Rate for Payer: UHCCP Medicaid |
$1.32
|
| 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
|
$35.00
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Mclaren Medicaid |
$6.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: Meridian Medicaid |
$6.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UHC Medicaid |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$571.20
|
| Rate for Payer: Aetna Medicare |
$174.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.00
|
| Rate for Payer: BCBS Complete |
$124.39
|
| Rate for Payer: BCBS MAPPO |
$168.00
|
| Rate for Payer: BCBS Trust/PPO |
$552.45
|
| Rate for Payer: BCN Commercial |
$552.45
|
| Rate for Payer: BCN Medicare Advantage |
$168.00
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$604.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.00
|
| Rate for Payer: Mclaren Medicaid |
$118.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.40
|
| Rate for Payer: Meridian Medicaid |
$124.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.20
|
| Rate for Payer: Nomi Health Commercial |
$551.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.00
|
| Rate for Payer: PACE Senior Care Partners |
$159.60
|
| Rate for Payer: PACE SWMI |
$168.00
|
| Rate for Payer: PHP Commercial |
$571.20
|
| Rate for Payer: PHP Medicare Advantage |
$168.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$584.64
|
| Rate for Payer: Priority Health Medicare |
$169.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$467.71
|
| Rate for Payer: Railroad Medicare Medicare |
$168.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.36
|
| Rate for Payer: UHC Core |
$561.12
|
| Rate for Payer: UHC Exchange |
$168.00
|
| Rate for Payer: UHC Medicaid |
$118.47
|
| Rate for Payer: UHC Medicare Advantage |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$118.47
|
| Rate for Payer: VA VA |
$168.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.00
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$6.20
|
| 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: Opus (Opus Packaging Group) HMA |
$5.63
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.23
|
| 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
|
IP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$522.52 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Aetna Commercial |
$638.14
|
| Rate for Payer: BCBS Trust/PPO |
$620.04
|
| Rate for Payer: BCN Commercial |
$620.04
|
| 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: Opus (Opus Packaging Group) HMA |
$563.06
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.52
|
| 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
|
OP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.36 |
| 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 |
$138.96
|
| Rate for Payer: BCBS MAPPO |
$187.69
|
| Rate for Payer: BCBS Trust/PPO |
$617.19
|
| Rate for Payer: BCN Commercial |
$617.19
|
| 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: Mclaren Medicaid |
$132.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.07
|
| Rate for Payer: Meridian Medicaid |
$138.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: Nomi Health Commercial |
$615.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.06
|
| 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 Choice Medicaid |
$132.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.15
|
| Rate for Payer: Priority Health Medicare |
$189.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.52
|
| 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 Exchange |
$187.69
|
| Rate for Payer: UHC Medicaid |
$132.36
|
| Rate for Payer: UHC Medicare Advantage |
$187.69
|
| Rate for Payer: UHCCP Medicaid |
$132.36
|
| Rate for Payer: VA VA |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$29.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: BCBS Trust/PPO |
$24.57
|
| Rate for Payer: BCN Commercial |
$24.57
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$26.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.29
|
| Rate for Payer: Nomi Health Commercial |
$24.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.31
|
| Rate for Payer: PHP Commercial |
$25.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.18
|
| Rate for Payer: UHC Core |
$24.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.31
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| 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 |
$140.58
|
| Rate for Payer: BCBS MAPPO |
$189.88
|
| Rate for Payer: BCBS Trust/PPO |
$624.38
|
| Rate for Payer: BCN Commercial |
$624.38
|
| 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: Mclaren Medicaid |
$133.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.37
|
| Rate for Payer: Meridian Medicaid |
$140.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$208.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Nomi Health Commercial |
$622.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.62
|
| 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 Choice Medicaid |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Medicare |
$191.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$528.61
|
| 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 Exchange |
$189.88
|
| Rate for Payer: UHC Medicaid |
$133.90
|
| Rate for Payer: UHC Medicare Advantage |
$189.88
|
| Rate for Payer: UHCCP Medicaid |
$133.90
|
| Rate for Payer: VA VA |
$189.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$701.75
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.42 |
| Max. Negotiated Rate |
$631.58 |
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: BCBS Trust/PPO |
$579.58
|
| Rate for Payer: BCN Commercial |
$579.58
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Healthscope Commercial |
$631.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Nomi Health Commercial |
$575.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.31
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.54
|
| Rate for Payer: UHC Core |
$585.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.61 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: BCBS Trust/PPO |
$627.27
|
| Rate for Payer: BCN Commercial |
$627.27
|
| 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: Opus (Opus Packaging Group) HMA |
$569.62
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$528.61
|
| 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
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| 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 |
$1.41
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.25
|
| Rate for Payer: BCN Commercial |
$6.25
|
| 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: Mclaren Medicaid |
$1.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.00
|
| Rate for Payer: Meridian Medicaid |
$1.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.70
|
| 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 Choice Medicaid |
$1.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| 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 Exchange |
$1.90
|
| Rate for Payer: UHC Medicaid |
$1.34
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: UHCCP Medicaid |
$1.34
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$701.75
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.72 |
| Max. Negotiated Rate |
$631.58 |
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: Aetna Medicare |
$182.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.30
|
| Rate for Payer: BCBS Complete |
$129.89
|
| Rate for Payer: BCBS MAPPO |
$175.44
|
| Rate for Payer: BCBS Trust/PPO |
$576.91
|
| Rate for Payer: BCN Commercial |
$576.91
|
| Rate for Payer: BCN Medicare Advantage |
$175.44
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.44
|
| Rate for Payer: Healthscope Commercial |
$631.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.31
|
| Rate for Payer: Mclaren Medicaid |
$123.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.21
|
| Rate for Payer: Meridian Medicaid |
$129.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Nomi Health Commercial |
$575.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.31
|
| Rate for Payer: PACE Senior Care Partners |
$166.67
|
| Rate for Payer: PACE SWMI |
$175.44
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: PHP Medicare Advantage |
$175.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.52
|
| Rate for Payer: Priority Health Medicare |
$177.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.42
|
| Rate for Payer: Railroad Medicare Medicare |
$175.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.54
|
| Rate for Payer: UHC Core |
$585.96
|
| Rate for Payer: UHC Exchange |
$175.44
|
| Rate for Payer: UHC Medicaid |
$123.72
|
| Rate for Payer: UHC Medicare Advantage |
$175.44
|
| Rate for Payer: UHCCP Medicaid |
$123.72
|
| Rate for Payer: VA VA |
$175.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCN Commercial |
$6.28
|
| 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: Opus (Opus Packaging Group) HMA |
$5.70
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| 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
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.34 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: BCBS Trust/PPO |
$237.74
|
| Rate for Payer: BCN Commercial |
$237.74
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.31
|
| Rate for Payer: UHC Core |
$240.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Medicare |
$74.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.95
|
| Rate for Payer: BCBS Complete |
$53.28
|
| Rate for Payer: BCBS MAPPO |
$71.96
|
| Rate for Payer: BCBS Trust/PPO |
$236.64
|
| Rate for Payer: BCN Commercial |
$236.64
|
| Rate for Payer: BCN Medicare Advantage |
$71.96
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.96
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Mclaren Medicaid |
$50.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.56
|
| Rate for Payer: Meridian Medicaid |
$53.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PACE Senior Care Partners |
$68.36
|
| Rate for Payer: PACE SWMI |
$71.96
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: PHP Medicare Advantage |
$71.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.43
|
| Rate for Payer: Priority Health Medicare |
$72.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.34
|
| Rate for Payer: Railroad Medicare Medicare |
$71.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.31
|
| Rate for Payer: UHC Core |
$240.35
|
| Rate for Payer: UHC Exchange |
$71.96
|
| Rate for Payer: UHC Medicaid |
$50.75
|
| Rate for Payer: UHC Medicare Advantage |
$71.96
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: VA VA |
$71.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.44
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: BCN Medicare Advantage |
$21.15
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.21
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.09
|
| Rate for Payer: PACE SWMI |
$21.15
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$21.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: UHC Exchange |
$21.15
|
| Rate for Payer: UHC Medicaid |
$14.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.15
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: VA VA |
$21.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
