|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$224.93
|
|
|
Service Code
|
NDC 62332036606
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.97 |
| Max. Negotiated Rate |
$202.44 |
| Rate for Payer: Aetna American Axle |
$146.20
|
| Rate for Payer: Aetna Commercial |
$191.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.20
|
| Rate for Payer: Cash Price |
$179.94
|
| Rate for Payer: Cofinity Advantage |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$193.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.94
|
| Rate for Payer: Healthscope Commercial |
$202.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.70
|
| Rate for Payer: PHP Commercial |
$191.19
|
| Rate for Payer: Priority Health SBD |
$141.71
|
| Rate for Payer: UMR Bronson Commercial |
$98.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.70
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
NDC 00093929219
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna American Axle |
$2.71
|
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.71
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
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
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$224.93
|
|
|
Service Code
|
NDC 62332036606
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.22 |
| Max. Negotiated Rate |
$202.44 |
| Rate for Payer: Aetna American Axle |
$146.20
|
| Rate for Payer: Aetna Commercial |
$191.19
|
| Rate for Payer: Aetna Medicare |
$112.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.20
|
| Rate for Payer: BCBS Complete |
$89.97
|
| Rate for Payer: Cash Price |
$179.94
|
| Rate for Payer: Cofinity Advantage |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$193.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.94
|
| Rate for Payer: Healthscope Commercial |
$202.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.70
|
| Rate for Payer: PHP Commercial |
$191.19
|
| Rate for Payer: Priority Health SBD |
$141.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.20
|
| Rate for Payer: UHC Core |
$117.19
|
| Rate for Payer: UHC Exchange |
$88.40
|
| Rate for Payer: UMR Bronson Commercial |
$83.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.70
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$249.99
|
|
|
Service Code
|
NDC 00093929267
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: BCBS Complete |
$100.00
|
| 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: MI Amish Medical Board Commercial |
$199.99
|
| 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: UHC All Payor (Choice/PPO) |
$162.49
|
| Rate for Payer: UHC Core |
$130.24
|
| Rate for Payer: UHC Exchange |
$98.25
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$403.38
|
|
|
Service Code
|
NDC 50268017315
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$363.04 |
| Rate for Payer: Aetna American Axle |
$262.20
|
| Rate for Payer: Aetna Commercial |
$342.87
|
| Rate for Payer: Aetna Medicare |
$201.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.20
|
| Rate for Payer: BCBS Complete |
$161.35
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: Cofinity Advantage |
$282.37
|
| Rate for Payer: Cofinity Commercial |
$346.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.70
|
| Rate for Payer: Healthscope Commercial |
$363.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.54
|
| Rate for Payer: PHP Commercial |
$342.87
|
| Rate for Payer: Priority Health SBD |
$254.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.20
|
| Rate for Payer: UHC Core |
$210.16
|
| Rate for Payer: UHC Exchange |
$158.53
|
| Rate for Payer: UMR Bronson Commercial |
$149.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.54
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 00093083201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.85
|
| Rate for Payer: UHC Core |
$25.53
|
| Rate for Payer: UHC Exchange |
$19.26
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$52.50
|
|
|
Service Code
|
NDC 59651072201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Advantage |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.38
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.12
|
| Rate for Payer: UHC Core |
$27.35
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$403.38
|
|
|
Service Code
|
NDC 50268017315
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.49 |
| Max. Negotiated Rate |
$363.04 |
| Rate for Payer: Aetna American Axle |
$262.20
|
| Rate for Payer: Aetna Commercial |
$342.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.20
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: Cofinity Advantage |
$282.37
|
| Rate for Payer: Cofinity Commercial |
$346.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.70
|
| Rate for Payer: Healthscope Commercial |
$363.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.54
|
| Rate for Payer: PHP Commercial |
$342.87
|
| Rate for Payer: Priority Health SBD |
$254.13
|
| Rate for Payer: UMR Bronson Commercial |
$177.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.54
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$8.07
|
|
|
Service Code
|
NDC 50268017311
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna American Axle |
$5.25
|
| Rate for Payer: Aetna Commercial |
$6.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.25
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Advantage |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.05
|
| Rate for Payer: PHP Commercial |
$6.86
|
| Rate for Payer: Priority Health SBD |
$5.08
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.05
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$78.75
|
|
|
Service Code
|
NDC 16729013616
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna American Axle |
$51.19
|
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.19
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Advantage |
$55.12
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.06
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health SBD |
$49.61
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$928.20
|
|
|
Service Code
|
NDC 00004006801
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.43 |
| Max. Negotiated Rate |
$835.38 |
| Rate for Payer: Aetna American Axle |
$603.33
|
| Rate for Payer: Aetna Commercial |
$788.97
|
| Rate for Payer: Aetna Medicare |
$464.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.33
|
| Rate for Payer: BCBS Complete |
$371.28
|
| Rate for Payer: Cash Price |
$742.56
|
| Rate for Payer: Cofinity Advantage |
$649.74
|
| Rate for Payer: Cofinity Commercial |
$798.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.56
|
| Rate for Payer: Healthscope Commercial |
$835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.15
|
| Rate for Payer: PHP Commercial |
$788.97
|
| Rate for Payer: Priority Health SBD |
$584.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.33
|
| Rate for Payer: UHC Core |
$483.59
|
| Rate for Payer: UHC Exchange |
$364.78
|
| Rate for Payer: UMR Bronson Commercial |
$343.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.15
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 00093083201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
NDC 00093083205
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Advantage |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.75
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$8.07
|
|
|
Service Code
|
NDC 50268017311
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna American Axle |
$5.25
|
| Rate for Payer: Aetna Commercial |
$6.86
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.25
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Advantage |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.05
|
| Rate for Payer: PHP Commercial |
$6.86
|
| Rate for Payer: Priority Health SBD |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.25
|
| Rate for Payer: UHC Core |
$4.20
|
| Rate for Payer: UHC Exchange |
$3.17
|
| Rate for Payer: UMR Bronson Commercial |
$2.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.05
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
NDC 00093083205
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Advantage |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.75
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.25
|
| Rate for Payer: UHC Core |
$127.64
|
| Rate for Payer: UHC Exchange |
$96.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$47.25
|
|
|
Service Code
|
NDC 72888015201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna American Axle |
$30.71
|
| Rate for Payer: Aetna Commercial |
$40.16
|
| Rate for Payer: Aetna Medicare |
$23.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cofinity Advantage |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.44
|
| Rate for Payer: PHP Commercial |
$40.16
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.71
|
| Rate for Payer: UHC Core |
$24.62
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.44
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$29.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cofinity Advantage |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$26.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.31
|
| Rate for Payer: PHP Commercial |
$25.29
|
| Rate for Payer: Priority Health SBD |
$18.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.34
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Exchange |
$11.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.31
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$928.20
|
|
|
Service Code
|
NDC 00004006801
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.41 |
| Max. Negotiated Rate |
$835.38 |
| Rate for Payer: Aetna American Axle |
$603.33
|
| Rate for Payer: Aetna Commercial |
$788.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.33
|
| Rate for Payer: Cash Price |
$742.56
|
| Rate for Payer: Cofinity Advantage |
$649.74
|
| Rate for Payer: Cofinity Commercial |
$798.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.56
|
| Rate for Payer: Healthscope Commercial |
$835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.15
|
| Rate for Payer: PHP Commercial |
$788.97
|
| Rate for Payer: Priority Health SBD |
$584.77
|
| Rate for Payer: UMR Bronson Commercial |
$408.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.15
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
NDC 59651072201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Advantage |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.38
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$78.75
|
|
|
Service Code
|
NDC 16729013616
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna American Axle |
$51.19
|
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.19
|
| Rate for Payer: BCBS Complete |
$31.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Advantage |
$55.12
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.06
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health SBD |
$49.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.19
|
| Rate for Payer: UHC Core |
$41.03
|
| Rate for Payer: UHC Exchange |
$30.95
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.68 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna American Axle |
$436.80
|
| Rate for Payer: Aetna Commercial |
$571.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.80
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Advantage |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.60
|
| Rate for Payer: Healthscope Commercial |
$604.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.00
|
| Rate for Payer: PHP Commercial |
$571.20
|
| Rate for Payer: Priority Health SBD |
$423.36
|
| Rate for Payer: UMR Bronson Commercial |
$295.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.00
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$29.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cofinity Advantage |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$26.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.31
|
| Rate for Payer: PHP Commercial |
$25.29
|
| Rate for Payer: Priority Health SBD |
$18.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.31
|
|
