|
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
|
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
|
OP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.78 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Aetna American Axle |
$487.99
|
| Rate for Payer: Aetna Commercial |
$638.14
|
| Rate for Payer: Aetna Medicare |
$375.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.99
|
| Rate for Payer: BCBS Complete |
$300.30
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cofinity Advantage |
$525.52
|
| Rate for Payer: Cofinity Commercial |
$645.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.60
|
| Rate for Payer: Healthscope Commercial |
$675.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$525.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$600.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.06
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: Priority Health SBD |
$472.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.99
|
| Rate for Payer: UHC Core |
$391.14
|
| Rate for Payer: UHC Exchange |
$295.04
|
| Rate for Payer: UMR Bronson Commercial |
$277.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna American Axle |
$4.88
|
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.88
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Advantage |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.63
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health SBD |
$4.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
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
|
OP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna American Axle |
$4.88
|
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: Aetna Medicare |
$3.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.88
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Advantage |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.63
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health SBD |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.88
|
| Rate for Payer: UHC Core |
$3.91
|
| Rate for Payer: UHC Exchange |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna American Axle |
$493.68
|
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.68
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Advantage |
$531.65
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.62
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health SBD |
$478.49
|
| Rate for Payer: UMR Bronson Commercial |
$334.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
NDC 16729013700
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Advantage |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.62
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna American Axle |
$4.94
|
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.94
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Advantage |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.70
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.94
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$701.75
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.77 |
| Max. Negotiated Rate |
$631.58 |
| Rate for Payer: Aetna American Axle |
$456.14
|
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cofinity Advantage |
$491.23
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Healthscope Commercial |
$631.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.31
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: Priority Health SBD |
$442.10
|
| Rate for Payer: UMR Bronson Commercial |
$308.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$701.75
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$631.58 |
| Rate for Payer: Aetna American Axle |
$456.14
|
| Rate for Payer: Aetna Commercial |
$596.49
|
| Rate for Payer: Aetna Medicare |
$350.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: BCBS Complete |
$280.70
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cofinity Advantage |
$491.23
|
| Rate for Payer: Cofinity Commercial |
$603.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.40
|
| Rate for Payer: Healthscope Commercial |
$631.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.31
|
| Rate for Payer: PHP Commercial |
$596.49
|
| Rate for Payer: Priority Health SBD |
$442.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.14
|
| Rate for Payer: UHC Core |
$365.61
|
| Rate for Payer: UHC Exchange |
$275.79
|
| Rate for Payer: UMR Bronson Commercial |
$259.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.31
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 51079088220
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Advantage |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$52.50
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
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 1 MG TABLET
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.25
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Advantage |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.96
|
| Rate for Payer: UHC Core |
$0.77
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna American Axle |
$4.94
|
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.94
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Advantage |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.70
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 16729013700
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$15.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Advantage |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.62
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$16.41
|
| Rate for Payer: UHC Exchange |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Advantage |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
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 1 MG TABLET
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 51079088220
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Advantage |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.55
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: UHC Exchange |
$57.77
|
| Rate for Payer: UMR Bronson Commercial |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna American Axle |
$493.68
|
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna Medicare |
$379.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.68
|
| Rate for Payer: BCBS Complete |
$303.80
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Advantage |
$531.65
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.62
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health SBD |
$478.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.68
|
| Rate for Payer: UHC Core |
$395.70
|
| Rate for Payer: UHC Exchange |
$298.48
|
| Rate for Payer: UMR Bronson Commercial |
$281.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$122.67
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna American Axle |
$79.74
|
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna Medicare |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.74
|
| Rate for Payer: BCBS Complete |
$49.07
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cofinity Advantage |
$85.87
|
| Rate for Payer: Cofinity Commercial |
$105.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.14
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.74
|
| Rate for Payer: UHC Core |
$63.91
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UMR Bronson Commercial |
$45.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$364.72
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna Medicare |
$182.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$313.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.07
|
| Rate for Payer: UHC Core |
$190.02
|
| Rate for Payer: UHC Exchange |
$143.33
|
| Rate for Payer: UMR Bronson Commercial |
$134.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$122.67
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna American Axle |
$79.74
|
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.74
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cofinity Advantage |
$85.87
|
| Rate for Payer: Cofinity Commercial |
$105.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.14
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$91.18
|
|
|
Service Code
|
NDC 00378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna American Axle |
$59.27
|
| Rate for Payer: Aetna Commercial |
$77.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.27
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Advantage |
$63.83
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.39
|
| Rate for Payer: PHP Commercial |
$77.50
|
| Rate for Payer: Priority Health SBD |
$57.44
|
| Rate for Payer: UMR Bronson Commercial |
$40.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.39
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 75907002311
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.94
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
