|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
185673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: PHP Commercial |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.11
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
185673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.26
|
| Rate for Payer: Aetna Medicare |
$5.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.36
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: BCBS MAPPO |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.50
|
| Rate for Payer: BCN Commercial |
$13.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.09
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$1.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.11
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.34
|
| Rate for Payer: Meridian Medicaid |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: PACE Medicare |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.09
|
| Rate for Payer: PHP Commercial |
$1.26
|
| Rate for Payer: PHP Medicare Advantage |
$5.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.19
|
| Rate for Payer: Priority Health Medicare |
$5.09
|
| Rate for Payer: Priority Health Narrow Network |
$11.35
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.09
|
| Rate for Payer: UHC Exchange |
$9.73
|
| Rate for Payer: UHC Medicare Advantage |
$5.09
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: VA VA |
$5.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.11
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 51079078801
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cofinity Commercial |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$4.96
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| 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 Commercial |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$495.25
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.91 |
| Max. Negotiated Rate |
$445.72 |
| Rate for Payer: Aetna American Axle |
$321.91
|
| Rate for Payer: Aetna Commercial |
$420.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.91
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: Cofinity Commercial |
$346.68
|
| Rate for Payer: Cofinity Commercial |
$425.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.20
|
| Rate for Payer: Healthscope Commercial |
$445.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.96
|
| Rate for Payer: PHP Commercial |
$420.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.91
|
| Rate for Payer: Priority Health SBD |
$312.01
|
| Rate for Payer: UMR Bronson Commercial |
$217.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.44
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
NDC 51079078820
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$1,976.13
|
|
|
Service Code
|
NDC 00009002901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$731.17 |
| Max. Negotiated Rate |
$1,778.52 |
| Rate for Payer: Aetna American Axle |
$1,284.48
|
| Rate for Payer: Aetna Commercial |
$1,679.71
|
| Rate for Payer: Aetna Medicare |
$988.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.48
|
| Rate for Payer: BCBS Complete |
$790.45
|
| Rate for Payer: Cash Price |
$1,580.90
|
| Rate for Payer: Cofinity Commercial |
$1,383.29
|
| Rate for Payer: Cofinity Commercial |
$1,699.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,383.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.90
|
| Rate for Payer: Healthscope Commercial |
$1,778.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,383.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,482.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.71
|
| Rate for Payer: PHP Commercial |
$1,679.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.48
|
| Rate for Payer: Priority Health SBD |
$1,244.96
|
| Rate for Payer: UMR Bronson Commercial |
$731.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,482.10
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna American Axle |
$37.54
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna Medicare |
$28.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.54
|
| Rate for Payer: BCBS Complete |
$23.10
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$51.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.09
|
| Rate for Payer: PHP Commercial |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.54
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.31
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 51079078801
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| 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 Commercial |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| 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 Commercial |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$23.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 51079078820
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| 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 Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.32
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna Medicare |
$40.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.32
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.32
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$29.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.32
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.32
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.32
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$495.25
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.24 |
| Max. Negotiated Rate |
$445.72 |
| Rate for Payer: Aetna American Axle |
$321.91
|
| Rate for Payer: Aetna Commercial |
$420.96
|
| Rate for Payer: Aetna Medicare |
$247.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.91
|
| Rate for Payer: BCBS Complete |
$198.10
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: Cofinity Commercial |
$346.68
|
| Rate for Payer: Cofinity Commercial |
$425.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.20
|
| Rate for Payer: Healthscope Commercial |
$445.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.96
|
| Rate for Payer: PHP Commercial |
$420.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.91
|
| Rate for Payer: Priority Health SBD |
$312.01
|
| Rate for Payer: UMR Bronson Commercial |
$183.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.44
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$51.98 |
| Rate for Payer: Aetna American Axle |
$37.54
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.54
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$49.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$51.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.09
|
| Rate for Payer: PHP Commercial |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.54
|
| Rate for Payer: Priority Health SBD |
$36.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.31
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$1,976.13
|
|
|
Service Code
|
NDC 00009002901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$1,778.52 |
| Rate for Payer: Aetna American Axle |
$1,284.48
|
| Rate for Payer: Aetna Commercial |
$1,679.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.48
|
| Rate for Payer: Cash Price |
$1,580.90
|
| Rate for Payer: Cofinity Commercial |
$1,383.29
|
| Rate for Payer: Cofinity Commercial |
$1,699.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,383.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.90
|
| Rate for Payer: Healthscope Commercial |
$1,778.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,383.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,482.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.71
|
| Rate for Payer: PHP Commercial |
$1,679.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.48
|
| Rate for Payer: Priority Health SBD |
$1,244.96
|
| Rate for Payer: UMR Bronson Commercial |
$869.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,482.10
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$4.96
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
NDC 65862067705
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$90.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 00781107701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna American Axle |
$35.26
|
| 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 Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.26
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UMR Bronson Commercial |
$23.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.69
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| 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 Commercial |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.70
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$83.48 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| 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 Commercial |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.29
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.56
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$78.75
|
|
|
Service Code
|
NDC 00228202910
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna American Axle |
$51.19
|
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.19
|
| Rate for Payer: BCBS Complete |
$31.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$55.12
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.94
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.19
|
| Rate for Payer: Priority Health SBD |
$49.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
