|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 68084060811
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.31
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Exchange |
$1.40
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$319.20
|
|
|
Service Code
|
NDC 57664005372
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.10 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna Medicare |
$159.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: BCBS Complete |
$127.68
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Advantage |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.40
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.48
|
| Rate for Payer: UHC Core |
$166.30
|
| Rate for Payer: UHC Exchange |
$125.45
|
| Rate for Payer: UMR Bronson Commercial |
$118.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 57664005372
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Advantage |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.40
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 50111045001
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$146.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Advantage |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.31
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.94
|
| Rate for Payer: UHC Core |
$153.04
|
| Rate for Payer: UHC Exchange |
$115.44
|
| Rate for Payer: UMR Bronson Commercial |
$108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
NDC 68084060811
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$308.75
|
|
|
Service Code
|
NDC 00904721261
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna Medicare |
$154.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: BCBS Complete |
$123.50
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Advantage |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.69
|
| Rate for Payer: UHC Core |
$160.86
|
| Rate for Payer: UHC Exchange |
$121.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$354.35
|
|
|
Service Code
|
NDC 68084060801
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna American Axle |
$230.33
|
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna Medicare |
$177.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: BCBS Complete |
$141.74
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Advantage |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.76
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.33
|
| Rate for Payer: UHC Core |
$184.62
|
| Rate for Payer: UHC Exchange |
$139.26
|
| Rate for Payer: UMR Bronson Commercial |
$131.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.76
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 00904721261
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna American Axle |
$200.69
|
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.69
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Advantage |
$216.12
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: Priority Health SBD |
$194.51
|
| Rate for Payer: UMR Bronson Commercial |
$135.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 50111045001
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Advantage |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.31
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$354.35
|
|
|
Service Code
|
NDC 68084060801
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.91 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna American Axle |
$230.33
|
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Advantage |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.76
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UMR Bronson Commercial |
$155.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.76
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
NDC 09900000314
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Advantage |
$0.64
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.69
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: Priority Health SBD |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.60
|
| Rate for Payer: UHC Core |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.36
|
| Rate for Payer: UMR Bronson Commercial |
$0.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.92
|
|
|
Service Code
|
NDC 09900000314
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Advantage |
$0.64
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.69
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: Priority Health SBD |
$0.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 68382080501
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Advantage |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 13107007901
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Advantage |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.27
|
| Rate for Payer: UHC Core |
$56.32
|
| Rate for Payer: UHC Exchange |
$42.48
|
| Rate for Payer: UMR Bronson Commercial |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.21
|
| Rate for Payer: UHC Core |
$53.87
|
| Rate for Payer: UHC Exchange |
$40.64
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 13107007901
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Advantage |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 68382080501
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Advantage |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.27
|
| Rate for Payer: UHC Core |
$56.32
|
| Rate for Payer: UHC Exchange |
$42.48
|
| Rate for Payer: UMR Bronson Commercial |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.74
|
| Rate for Payer: UHC Core |
$1.40
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 13668033001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UMR Bronson Commercial |
$64.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 13668033001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$75.91
|
| Rate for Payer: UHC Exchange |
$57.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.86
|
| Rate for Payer: UHC Core |
$127.33
|
| Rate for Payer: UHC Exchange |
$96.05
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Advantage |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Advantage |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
