|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$561.75
|
|
|
Service Code
|
NDC 00832058011
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.17 |
| Max. Negotiated Rate |
$505.57 |
| Rate for Payer: Aetna American Axle |
$365.14
|
| Rate for Payer: Aetna Commercial |
$477.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.14
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cofinity Advantage |
$393.23
|
| Rate for Payer: Cofinity Commercial |
$483.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.40
|
| Rate for Payer: Healthscope Commercial |
$505.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.31
|
| Rate for Payer: PHP Commercial |
$477.49
|
| Rate for Payer: Priority Health SBD |
$353.90
|
| Rate for Payer: UMR Bronson Commercial |
$247.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.31
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$9,607.95
|
|
|
Service Code
|
NDC 67386031401
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,227.50 |
| Max. Negotiated Rate |
$8,647.16 |
| Rate for Payer: Aetna American Axle |
$6,245.17
|
| Rate for Payer: Aetna Commercial |
$8,166.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,245.17
|
| Rate for Payer: Cash Price |
$7,686.36
|
| Rate for Payer: Cofinity Advantage |
$6,725.56
|
| Rate for Payer: Cofinity Commercial |
$8,262.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,686.36
|
| Rate for Payer: Healthscope Commercial |
$8,647.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,725.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,205.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,166.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,205.96
|
| Rate for Payer: PHP Commercial |
$8,166.76
|
| Rate for Payer: Priority Health SBD |
$6,053.01
|
| Rate for Payer: UMR Bronson Commercial |
$4,227.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,205.96
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$976.50
|
|
|
Service Code
|
NDC 51991090001
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.66 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna American Axle |
$634.73
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.73
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cofinity Advantage |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.38
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UMR Bronson Commercial |
$429.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$976.50
|
|
|
Service Code
|
NDC 68180015701
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.66 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna American Axle |
$634.73
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.73
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cofinity Advantage |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.38
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UMR Bronson Commercial |
$429.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
OP
|
$976.50
|
|
|
Service Code
|
NDC 51991090001
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna American Axle |
$634.73
|
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: Aetna Medicare |
$488.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.73
|
| Rate for Payer: BCBS Complete |
$390.60
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cofinity Advantage |
$683.55
|
| Rate for Payer: Cofinity Commercial |
$839.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$878.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.38
|
| Rate for Payer: PHP Commercial |
$830.02
|
| Rate for Payer: Priority Health SBD |
$615.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.73
|
| Rate for Payer: UHC Core |
$508.76
|
| Rate for Payer: UHC Exchange |
$383.76
|
| Rate for Payer: UMR Bronson Commercial |
$361.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.38
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$485.64
|
|
|
Service Code
|
NDC 67877065861
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.68 |
| Max. Negotiated Rate |
$437.08 |
| Rate for Payer: Aetna American Axle |
$315.67
|
| Rate for Payer: Aetna Commercial |
$412.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.67
|
| Rate for Payer: Cash Price |
$388.51
|
| Rate for Payer: Cofinity Advantage |
$339.95
|
| Rate for Payer: Cofinity Commercial |
$417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.51
|
| Rate for Payer: Healthscope Commercial |
$437.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.23
|
| Rate for Payer: PHP Commercial |
$412.79
|
| Rate for Payer: Priority Health SBD |
$305.95
|
| Rate for Payer: UMR Bronson Commercial |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.23
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$5,390.61
|
|
|
Service Code
|
NDC 67386031321
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,371.87 |
| Max. Negotiated Rate |
$4,851.55 |
| Rate for Payer: Aetna American Axle |
$3,503.90
|
| Rate for Payer: Aetna Commercial |
$4,582.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,503.90
|
| Rate for Payer: Cash Price |
$4,312.49
|
| Rate for Payer: Cofinity Advantage |
$3,773.43
|
| Rate for Payer: Cofinity Commercial |
$4,635.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,312.49
|
| Rate for Payer: Healthscope Commercial |
$4,851.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,773.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,042.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,582.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,042.96
|
| Rate for Payer: PHP Commercial |
$4,582.02
|
| Rate for Payer: Priority Health SBD |
$3,396.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,371.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,042.96
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$602.50
|
|
|
Service Code
|
NDC 69452011645
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.93 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Aetna American Axle |
$391.62
|
| Rate for Payer: Aetna Commercial |
$512.12
|
| Rate for Payer: Aetna Medicare |
$301.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.62
|
| Rate for Payer: BCBS Complete |
$241.00
|
| Rate for Payer: Cash Price |
$482.00
|
| Rate for Payer: Cofinity Advantage |
$421.75
|
| Rate for Payer: Cofinity Commercial |
$518.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.00
|
| Rate for Payer: Healthscope Commercial |
$542.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$482.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.88
|
| Rate for Payer: PHP Commercial |
$512.12
|
| Rate for Payer: Priority Health SBD |
$379.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.62
|
| Rate for Payer: UHC Core |
$313.90
|
| Rate for Payer: UHC Exchange |
$236.78
|
| Rate for Payer: UMR Bronson Commercial |
$222.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.88
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$101.03
|
|
|
Service Code
|
NDC 09900000626
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$90.93 |
| Rate for Payer: Aetna American Axle |
$65.67
|
| Rate for Payer: Aetna Commercial |
$85.88
|
| Rate for Payer: Aetna Medicare |
$50.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.67
|
| Rate for Payer: BCBS Complete |
$40.41
|
| Rate for Payer: Cash Price |
$80.82
|
| Rate for Payer: Cofinity Advantage |
$70.72
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.82
|
| Rate for Payer: Healthscope Commercial |
$90.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.77
|
| Rate for Payer: PHP Commercial |
$85.88
|
| Rate for Payer: Priority Health SBD |
$63.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.67
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Exchange |
$39.70
|
| Rate for Payer: UMR Bronson Commercial |
$37.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.77
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
NDC 09900000597
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.28
|
| Rate for Payer: UHC Core |
$7.44
|
| Rate for Payer: UHC Exchange |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$485.64
|
|
|
Service Code
|
NDC 67877065861
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.69 |
| Max. Negotiated Rate |
$437.08 |
| Rate for Payer: Aetna American Axle |
$315.67
|
| Rate for Payer: Aetna Commercial |
$412.79
|
| Rate for Payer: Aetna Medicare |
$242.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.67
|
| Rate for Payer: BCBS Complete |
$194.26
|
| Rate for Payer: Cash Price |
$388.51
|
| Rate for Payer: Cofinity Advantage |
$339.95
|
| Rate for Payer: Cofinity Commercial |
$417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.51
|
| Rate for Payer: Healthscope Commercial |
$437.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.23
|
| Rate for Payer: PHP Commercial |
$412.79
|
| Rate for Payer: Priority Health SBD |
$305.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.67
|
| Rate for Payer: UHC Core |
$253.02
|
| Rate for Payer: UHC Exchange |
$190.86
|
| Rate for Payer: UMR Bronson Commercial |
$179.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.23
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$602.50
|
|
|
Service Code
|
NDC 69452011645
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.10 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Aetna American Axle |
$391.62
|
| Rate for Payer: Aetna Commercial |
$512.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.62
|
| Rate for Payer: Cash Price |
$482.00
|
| Rate for Payer: Cofinity Advantage |
$421.75
|
| Rate for Payer: Cofinity Commercial |
$518.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.00
|
| Rate for Payer: Healthscope Commercial |
$542.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.88
|
| Rate for Payer: PHP Commercial |
$512.12
|
| Rate for Payer: Priority Health SBD |
$379.57
|
| Rate for Payer: UMR Bronson Commercial |
$265.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.88
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$101.03
|
|
|
Service Code
|
NDC 09900000626
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.45 |
| Max. Negotiated Rate |
$90.93 |
| Rate for Payer: Aetna American Axle |
$65.67
|
| Rate for Payer: Aetna Commercial |
$85.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.67
|
| Rate for Payer: Cash Price |
$80.82
|
| Rate for Payer: Cofinity Advantage |
$70.72
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.82
|
| Rate for Payer: Healthscope Commercial |
$90.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.77
|
| Rate for Payer: PHP Commercial |
$85.88
|
| Rate for Payer: Priority Health SBD |
$63.65
|
| Rate for Payer: UMR Bronson Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.77
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$437.76
|
|
|
Service Code
|
NDC 69238153502
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.61 |
| Max. Negotiated Rate |
$393.98 |
| Rate for Payer: Aetna American Axle |
$284.54
|
| Rate for Payer: Aetna Commercial |
$372.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.54
|
| Rate for Payer: Cash Price |
$350.21
|
| Rate for Payer: Cofinity Advantage |
$306.43
|
| Rate for Payer: Cofinity Commercial |
$376.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.21
|
| Rate for Payer: Healthscope Commercial |
$393.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.32
|
| Rate for Payer: PHP Commercial |
$372.10
|
| Rate for Payer: Priority Health SBD |
$275.79
|
| Rate for Payer: UMR Bronson Commercial |
$192.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.32
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$5,390.61
|
|
|
Service Code
|
NDC 67386031321
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,994.53 |
| Max. Negotiated Rate |
$4,851.55 |
| Rate for Payer: Aetna American Axle |
$3,503.90
|
| Rate for Payer: Aetna Commercial |
$4,582.02
|
| Rate for Payer: Aetna Medicare |
$2,695.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,503.90
|
| Rate for Payer: BCBS Complete |
$2,156.24
|
| Rate for Payer: Cash Price |
$4,312.49
|
| Rate for Payer: Cofinity Advantage |
$3,773.43
|
| Rate for Payer: Cofinity Commercial |
$4,635.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,312.49
|
| Rate for Payer: Healthscope Commercial |
$4,851.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,773.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,042.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,312.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,582.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,042.96
|
| Rate for Payer: PHP Commercial |
$4,582.02
|
| Rate for Payer: Priority Health SBD |
$3,396.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,503.90
|
| Rate for Payer: UHC Core |
$2,808.51
|
| Rate for Payer: UHC Exchange |
$2,118.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,994.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,042.96
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
NDC 09900000597
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$437.76
|
|
|
Service Code
|
NDC 69238153502
|
| Hospital Charge Code |
167603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$393.98 |
| Rate for Payer: Aetna American Axle |
$284.54
|
| Rate for Payer: Aetna Commercial |
$372.10
|
| Rate for Payer: Aetna Medicare |
$218.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.54
|
| Rate for Payer: BCBS Complete |
$175.10
|
| Rate for Payer: Cash Price |
$350.21
|
| Rate for Payer: Cofinity Advantage |
$306.43
|
| Rate for Payer: Cofinity Commercial |
$376.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.21
|
| Rate for Payer: Healthscope Commercial |
$393.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.32
|
| Rate for Payer: PHP Commercial |
$372.10
|
| Rate for Payer: Priority Health SBD |
$275.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.54
|
| Rate for Payer: UHC Core |
$228.07
|
| Rate for Payer: UHC Exchange |
$172.04
|
| Rate for Payer: UMR Bronson Commercial |
$161.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.32
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.55
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$52.61
|
|
|
Service Code
|
NDC 00168016315
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna American Axle |
$34.20
|
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: Cash Price |
$42.09
|
| Rate for Payer: Cofinity Advantage |
$36.83
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$47.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.46
|
| Rate for Payer: PHP Commercial |
$44.72
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.46
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna American Axle |
$13.56
|
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.56
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Advantage |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.64
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health SBD |
$13.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.56
|
| Rate for Payer: UHC Core |
$10.87
|
| Rate for Payer: UHC Exchange |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$52.61
|
|
|
Service Code
|
NDC 00168016315
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna American Axle |
$34.20
|
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Medicare |
$26.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: BCBS Complete |
$21.04
|
| Rate for Payer: Cash Price |
$42.09
|
| Rate for Payer: Cofinity Advantage |
$36.83
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$47.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.46
|
| Rate for Payer: PHP Commercial |
$44.72
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$27.41
|
| Rate for Payer: UHC Exchange |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$19.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.46
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna American Axle |
$13.56
|
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.56
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Advantage |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.64
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health SBD |
$13.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.55
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$16.96
|
| Rate for Payer: UHC Exchange |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 70700010615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Advantage |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.39
|
| Rate for Payer: UHC Core |
$20.35
|
| Rate for Payer: UHC Exchange |
$15.35
|
| Rate for Payer: UMR Bronson Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$78.12
|
|
|
Service Code
|
NDC 00713065615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Aetna American Axle |
$50.78
|
| Rate for Payer: Aetna Commercial |
$66.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.78
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cofinity Advantage |
$54.68
|
| Rate for Payer: Cofinity Commercial |
$67.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$70.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.59
|
| Rate for Payer: PHP Commercial |
$66.40
|
| Rate for Payer: Priority Health SBD |
$49.22
|
| Rate for Payer: UMR Bronson Commercial |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.59
|
|
