|
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
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
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 OINTMENT
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 70700010615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| 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: 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: UMR Bronson Commercial |
$17.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$78.12
|
|
|
Service Code
|
NDC 00713065615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Aetna American Axle |
$50.78
|
| Rate for Payer: Aetna Commercial |
$66.40
|
| Rate for Payer: Aetna Medicare |
$39.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.78
|
| Rate for Payer: BCBS Complete |
$31.25
|
| 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: MI Amish Medical Board Commercial |
$62.50
|
| 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: UHC All Payor (Choice/PPO) |
$50.78
|
| Rate for Payer: UHC Core |
$40.70
|
| Rate for Payer: UHC Exchange |
$30.70
|
| Rate for Payer: UMR Bronson Commercial |
$28.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.59
|
|
|
CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,002.20
|
|
|
Service Code
|
HCPCS J9027
|
| Hospital Charge Code |
40404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.97 |
| Max. Negotiated Rate |
$901.98 |
| Rate for Payer: Aetna American Axle |
$651.43
|
| Rate for Payer: Aetna American Axle |
$1,511.03
|
| Rate for Payer: Aetna American Axle |
$964.08
|
| Rate for Payer: Aetna Commercial |
$1,260.72
|
| Rate for Payer: Aetna Commercial |
$851.87
|
| Rate for Payer: Aetna Commercial |
$1,975.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.08
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cofinity Advantage |
$1,627.26
|
| Rate for Payer: Cofinity Advantage |
$701.54
|
| Rate for Payer: Cofinity Advantage |
$1,038.24
|
| Rate for Payer: Cofinity Commercial |
$1,999.21
|
| Rate for Payer: Cofinity Commercial |
$861.89
|
| Rate for Payer: Cofinity Commercial |
$1,275.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.73
|
| Rate for Payer: Healthscope Commercial |
$1,334.88
|
| Rate for Payer: Healthscope Commercial |
$2,092.19
|
| Rate for Payer: Healthscope Commercial |
$901.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,627.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,975.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,112.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.49
|
| Rate for Payer: PHP Commercial |
$1,260.72
|
| Rate for Payer: PHP Commercial |
$851.87
|
| Rate for Payer: PHP Commercial |
$1,975.96
|
| Rate for Payer: Priority Health SBD |
$631.39
|
| Rate for Payer: Priority Health SBD |
$934.42
|
| Rate for Payer: Priority Health SBD |
$1,464.54
|
| Rate for Payer: UMR Bronson Commercial |
$440.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,022.85
|
| Rate for Payer: UMR Bronson Commercial |
$652.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.49
|
|
|
CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,324.66
|
|
|
Service Code
|
HCPCS J9027
|
| Hospital Charge Code |
40404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$2,092.19 |
| Rate for Payer: Aetna American Axle |
$1,511.03
|
| Rate for Payer: Aetna American Axle |
$651.43
|
| Rate for Payer: Aetna American Axle |
$964.08
|
| Rate for Payer: Aetna Commercial |
$1,975.96
|
| Rate for Payer: Aetna Commercial |
$1,260.72
|
| Rate for Payer: Aetna Commercial |
$851.87
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.68
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$46.59
|
| Rate for Payer: BCBS Trust/PPO |
$46.59
|
| Rate for Payer: BCBS Trust/PPO |
$46.59
|
| Rate for Payer: BCN Commercial |
$46.59
|
| Rate for Payer: BCN Commercial |
$46.59
|
| Rate for Payer: BCN Commercial |
$46.59
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cofinity Advantage |
$701.54
|
| Rate for Payer: Cofinity Advantage |
$1,038.24
|
| Rate for Payer: Cofinity Advantage |
$1,627.26
|
| Rate for Payer: Cofinity Commercial |
$1,275.55
|
| Rate for Payer: Cofinity Commercial |
$1,999.21
|
| Rate for Payer: Cofinity Commercial |
$861.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$901.98
|
| Rate for Payer: Healthscope Commercial |
$1,334.88
|
| Rate for Payer: Healthscope Commercial |
$2,092.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,627.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.65
|
| Rate for Payer: Mclaren Medicaid |
$10.94
|
| Rate for Payer: Mclaren Medicaid |
$10.94
|
| Rate for Payer: Mclaren Medicaid |
$10.94
|
| Rate for Payer: Mclaren Medicare |
$10.94
|
| Rate for Payer: Mclaren Medicare |
$10.94
|
| Rate for Payer: Mclaren Medicare |
$10.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.49
|
| Rate for Payer: Meridian Medicaid |
$11.49
|
| Rate for Payer: Meridian Medicaid |
$11.49
|
| Rate for Payer: Meridian Medicaid |
$11.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,975.96
|
| Rate for Payer: Nomi Health Commercial |
$32.82
|
| Rate for Payer: Nomi Health Commercial |
$32.82
|
| Rate for Payer: Nomi Health Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,112.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.49
|
| Rate for Payer: PACE Medicare |
$10.39
|
| Rate for Payer: PACE Medicare |
$10.39
|
| Rate for Payer: PACE Medicare |
$10.39
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PHP Commercial |
$1,975.96
|
| Rate for Payer: PHP Commercial |
$851.87
|
| Rate for Payer: PHP Commercial |
$1,260.72
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.21
|
| Rate for Payer: Priority Health Medicare |
$10.94
|
| Rate for Payer: Priority Health Medicare |
$10.94
|
| Rate for Payer: Priority Health Medicare |
$10.94
|
| Rate for Payer: Priority Health SBD |
$1,464.54
|
| Rate for Payer: Priority Health SBD |
$934.42
|
| Rate for Payer: Priority Health SBD |
$631.39
|
| Rate for Payer: Priority Health Tiered Network |
$10.57
|
| Rate for Payer: Priority Health Tiered Network |
$10.57
|
| Rate for Payer: Priority Health Tiered Network |
$10.57
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.71
|
| Rate for Payer: UHC Core |
$23.71
|
| Rate for Payer: UHC Core |
$23.71
|
| Rate for Payer: UHC Core |
$23.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.94
|
| Rate for Payer: UHC Exchange |
$23.71
|
| Rate for Payer: UHC Exchange |
$23.71
|
| Rate for Payer: UHC Exchange |
$23.71
|
| Rate for Payer: UHC Medicaid |
$5.72
|
| Rate for Payer: UHC Medicaid |
$5.72
|
| Rate for Payer: UHC Medicaid |
$5.72
|
| Rate for Payer: UHCCP Medicaid |
$5.72
|
| Rate for Payer: UHCCP Medicaid |
$5.72
|
| Rate for Payer: UHCCP Medicaid |
$5.72
|
| Rate for Payer: UMR Bronson Commercial |
$548.78
|
| Rate for Payer: UMR Bronson Commercial |
$370.81
|
| Rate for Payer: UMR Bronson Commercial |
$860.12
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.40
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$88.35
|
|
|
Service Code
|
NDC 16571068303
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna Medicare |
$44.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Advantage |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.26
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.43
|
| Rate for Payer: UHC Core |
$46.03
|
| Rate for Payer: UHC Exchange |
$34.72
|
| Rate for Payer: UMR Bronson Commercial |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 51672401105
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$88.92
|
|
|
Service Code
|
NDC 42571034230
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna American Axle |
$57.80
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.69
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
NDC 51672401106
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 51672401105
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$88.35
|
|
|
Service Code
|
NDC 16571068303
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Advantage |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.26
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$88.92
|
|
|
Service Code
|
NDC 42571034230
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna American Axle |
$57.80
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: BCBS Complete |
$35.57
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.69
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.80
|
| Rate for Payer: UHC Core |
$46.33
|
| Rate for Payer: UHC Exchange |
$34.95
|
| Rate for Payer: UMR Bronson Commercial |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
NDC 51672401106
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$261.22
|
|
|
Service Code
|
NDC 57664078386
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$235.10 |
| Rate for Payer: Aetna American Axle |
$169.79
|
| Rate for Payer: Aetna Commercial |
$222.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.79
|
| Rate for Payer: Cash Price |
$208.98
|
| Rate for Payer: Cofinity Advantage |
$182.85
|
| Rate for Payer: Cofinity Commercial |
$224.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.98
|
| Rate for Payer: Healthscope Commercial |
$235.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.91
|
| Rate for Payer: PHP Commercial |
$222.04
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.91
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
NDC 49884030652
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 00093929019
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$250.56
|
|
|
Service Code
|
NDC 00093929067
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.71 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna American Axle |
$162.86
|
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: Aetna Medicare |
$125.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.86
|
| Rate for Payer: BCBS Complete |
$100.22
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Advantage |
$175.39
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.92
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health SBD |
$157.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.86
|
| Rate for Payer: UHC Core |
$130.54
|
| Rate for Payer: UHC Exchange |
$98.47
|
| Rate for Payer: UMR Bronson Commercial |
$92.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.92
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$247.40
|
|
|
Service Code
|
NDC 49884030602
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$222.66 |
| Rate for Payer: Aetna American Axle |
$160.81
|
| Rate for Payer: Aetna Commercial |
$210.29
|
| Rate for Payer: Aetna Medicare |
$123.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.81
|
| Rate for Payer: BCBS Complete |
$98.96
|
| Rate for Payer: Cash Price |
$197.92
|
| Rate for Payer: Cofinity Advantage |
$173.18
|
| Rate for Payer: Cofinity Commercial |
$212.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$222.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.55
|
| Rate for Payer: PHP Commercial |
$210.29
|
| Rate for Payer: Priority Health SBD |
$155.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.81
|
| Rate for Payer: UHC Core |
$128.90
|
| Rate for Payer: UHC Exchange |
$97.23
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.55
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$247.40
|
|
|
Service Code
|
NDC 49884030602
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.86 |
| Max. Negotiated Rate |
$222.66 |
| Rate for Payer: Aetna American Axle |
$160.81
|
| Rate for Payer: Aetna Commercial |
$210.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.81
|
| Rate for Payer: Cash Price |
$197.92
|
| Rate for Payer: Cofinity Advantage |
$173.18
|
| Rate for Payer: Cofinity Commercial |
$212.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$222.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.55
|
| Rate for Payer: PHP Commercial |
$210.29
|
| Rate for Payer: Priority Health SBD |
$155.86
|
| Rate for Payer: UMR Bronson Commercial |
$108.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.55
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 00093929019
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$250.56
|
|
|
Service Code
|
NDC 00093929067
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna American Axle |
$162.86
|
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.86
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Advantage |
$175.39
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.92
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health SBD |
$157.85
|
| Rate for Payer: UMR Bronson Commercial |
$110.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.92
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 49884030652
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.51
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$261.22
|
|
|
Service Code
|
NDC 57664078386
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$235.10 |
| Rate for Payer: Aetna American Axle |
$169.79
|
| Rate for Payer: Aetna Commercial |
$222.04
|
| Rate for Payer: Aetna Medicare |
$130.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.79
|
| Rate for Payer: BCBS Complete |
$104.49
|
| Rate for Payer: Cash Price |
$208.98
|
| Rate for Payer: Cofinity Advantage |
$182.85
|
| Rate for Payer: Cofinity Commercial |
$224.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.98
|
| Rate for Payer: Healthscope Commercial |
$235.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.91
|
| Rate for Payer: PHP Commercial |
$222.04
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.79
|
| Rate for Payer: UHC Core |
$136.10
|
| Rate for Payer: UHC Exchange |
$102.66
|
| Rate for Payer: UMR Bronson Commercial |
$96.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.91
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.99
|
|
|
Service Code
|
NDC 00093929267
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: Cash Price |
$199.99
|
| Rate for Payer: Cofinity Advantage |
$174.99
|
| Rate for Payer: Cofinity Commercial |
$214.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.99
|
| Rate for Payer: Healthscope Commercial |
$224.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health SBD |
$157.49
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
