|
ALLOPURINOL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,742.75
|
|
|
Service Code
|
HCPCS J0206
|
| Hospital Charge Code |
25408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$5,168.48 |
| Rate for Payer: Aetna American Axle |
$3,732.79
|
| Rate for Payer: Aetna American Axle |
$2,820.34
|
| Rate for Payer: Aetna American Axle |
$3,348.41
|
| Rate for Payer: Aetna Commercial |
$4,881.34
|
| Rate for Payer: Aetna Commercial |
$4,378.69
|
| Rate for Payer: Aetna Commercial |
$3,688.13
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,732.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.76
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS MAPPO |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$3.81
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$14.26
|
| Rate for Payer: BCN Commercial |
$14.26
|
| Rate for Payer: BCN Commercial |
$14.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.81
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$3,471.18
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Cash Price |
$3,471.18
|
| Rate for Payer: Cofinity Advantage |
$3,037.29
|
| Rate for Payer: Cofinity Advantage |
$3,605.98
|
| Rate for Payer: Cofinity Advantage |
$4,019.93
|
| Rate for Payer: Cofinity Commercial |
$4,430.20
|
| Rate for Payer: Cofinity Commercial |
$4,938.77
|
| Rate for Payer: Cofinity Commercial |
$3,731.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,594.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$3,905.08
|
| Rate for Payer: Healthscope Commercial |
$4,636.26
|
| Rate for Payer: Healthscope Commercial |
$5,168.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,605.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,019.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,863.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,307.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.24
|
| Rate for Payer: Mclaren Medicaid |
$3.81
|
| Rate for Payer: Mclaren Medicaid |
$3.81
|
| Rate for Payer: Mclaren Medicaid |
$3.81
|
| Rate for Payer: Mclaren Medicare |
$3.81
|
| Rate for Payer: Mclaren Medicare |
$3.81
|
| Rate for Payer: Mclaren Medicare |
$3.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.00
|
| Rate for Payer: Meridian Medicaid |
$4.00
|
| Rate for Payer: Meridian Medicaid |
$4.00
|
| Rate for Payer: Meridian Medicaid |
$4.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,688.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,378.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,881.34
|
| Rate for Payer: Nomi Health Commercial |
$11.43
|
| Rate for Payer: Nomi Health Commercial |
$11.43
|
| Rate for Payer: Nomi Health Commercial |
$11.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,254.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,863.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,307.06
|
| Rate for Payer: PACE Medicare |
$3.62
|
| Rate for Payer: PACE Medicare |
$3.62
|
| Rate for Payer: PACE Medicare |
$3.62
|
| Rate for Payer: PACE SWMI |
$3.81
|
| Rate for Payer: PACE SWMI |
$3.81
|
| Rate for Payer: PACE SWMI |
$3.81
|
| Rate for Payer: PHP Commercial |
$4,881.34
|
| Rate for Payer: PHP Commercial |
$3,688.13
|
| Rate for Payer: PHP Commercial |
$4,378.69
|
| Rate for Payer: PHP Medicare Advantage |
$3.81
|
| Rate for Payer: PHP Medicare Advantage |
$3.81
|
| Rate for Payer: PHP Medicare Advantage |
$3.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.88
|
| Rate for Payer: Priority Health Medicare |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$3.81
|
| Rate for Payer: Priority Health SBD |
$3,617.93
|
| Rate for Payer: Priority Health SBD |
$3,245.38
|
| Rate for Payer: Priority Health SBD |
$2,733.56
|
| Rate for Payer: Priority Health Tiered Network |
$11.90
|
| Rate for Payer: Priority Health Tiered Network |
$11.90
|
| Rate for Payer: Priority Health Tiered Network |
$11.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.26
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.81
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Exchange |
$7.26
|
| Rate for Payer: UHC Medicaid |
$1.99
|
| Rate for Payer: UHC Medicaid |
$1.99
|
| Rate for Payer: UHC Medicaid |
$1.99
|
| Rate for Payer: UHCCP Medicaid |
$1.99
|
| Rate for Payer: UHCCP Medicaid |
$1.99
|
| Rate for Payer: UHCCP Medicaid |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,906.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,605.42
|
| Rate for Payer: UMR Bronson Commercial |
$2,124.82
|
| Rate for Payer: VA VA |
$3.81
|
| Rate for Payer: VA VA |
$3.81
|
| Rate for Payer: VA VA |
$3.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,307.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,863.55
|
|
|
ALOE VERA-COLLAGEN TOPICAL FOAM
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
NDC 68455010841
|
| Hospital Charge Code |
108259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Advantage |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.07
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ALOE VERA-COLLAGEN TOPICAL FOAM
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
NDC 68455010841
|
| Hospital Charge Code |
108259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Advantage |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.07
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.26
|
| Rate for Payer: UHC Core |
$14.63
|
| Rate for Payer: UHC Exchange |
$11.04
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ALOSETRON 1 MG TABLET
|
Facility
|
OP
|
$1,066.71
|
|
|
Service Code
|
NDC 65162024903
|
| Hospital Charge Code |
27127
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.68 |
| Max. Negotiated Rate |
$960.04 |
| Rate for Payer: Aetna American Axle |
$693.36
|
| Rate for Payer: Aetna Commercial |
$906.70
|
| Rate for Payer: Aetna Medicare |
$533.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.36
|
| Rate for Payer: BCBS Complete |
$426.68
|
| Rate for Payer: Cash Price |
$853.37
|
| Rate for Payer: Cofinity Advantage |
$746.70
|
| Rate for Payer: Cofinity Commercial |
$917.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.37
|
| Rate for Payer: Healthscope Commercial |
$960.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$746.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$853.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$800.03
|
| Rate for Payer: PHP Commercial |
$906.70
|
| Rate for Payer: Priority Health SBD |
$672.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.36
|
| Rate for Payer: UHC Core |
$555.76
|
| Rate for Payer: UHC Exchange |
$419.22
|
| Rate for Payer: UMR Bronson Commercial |
$394.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.03
|
|
|
ALOSETRON 1 MG TABLET
|
Facility
|
IP
|
$1,066.71
|
|
|
Service Code
|
NDC 65162024903
|
| Hospital Charge Code |
27127
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.35 |
| Max. Negotiated Rate |
$960.04 |
| Rate for Payer: Aetna American Axle |
$693.36
|
| Rate for Payer: Aetna Commercial |
$906.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.36
|
| Rate for Payer: Cash Price |
$853.37
|
| Rate for Payer: Cofinity Advantage |
$746.70
|
| Rate for Payer: Cofinity Commercial |
$917.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.37
|
| Rate for Payer: Healthscope Commercial |
$960.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$746.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$800.03
|
| Rate for Payer: PHP Commercial |
$906.70
|
| Rate for Payer: Priority Health SBD |
$672.03
|
| Rate for Payer: UMR Bronson Commercial |
$469.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.03
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
185673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.26
|
| Rate for Payer: Aetna Medicare |
$5.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$17.41
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Advantage |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$1.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.11
|
| Rate for Payer: Mclaren Medicaid |
$5.14
|
| Rate for Payer: Mclaren Medicare |
$5.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.40
|
| Rate for Payer: Meridian Medicaid |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: PACE Medicare |
$4.88
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PHP Commercial |
$1.26
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.21
|
| Rate for Payer: Priority Health Medicare |
$5.14
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: Priority Health Tiered Network |
$13.77
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.86
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.14
|
| Rate for Payer: UHC Exchange |
$8.86
|
| Rate for Payer: UHC Medicaid |
$2.69
|
| Rate for Payer: UHCCP Medicaid |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: VA VA |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.11
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$78.75
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
324
|
|
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
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna American Axle |
$35.26
|
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: BCBS Complete |
$21.70
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$28.26
|
| Rate for Payer: UHC Exchange |
$21.32
|
| Rate for Payer: UMR Bronson Commercial |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.69
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Advantage |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.30
|
| Rate for Payer: UHC Core |
$21.88
|
| Rate for Payer: UHC Exchange |
$16.51
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
NDC 51079078820
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Advantage |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.25
|
| Rate for Payer: UHC Core |
$54.70
|
| Rate for Payer: UHC Exchange |
$41.27
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 51079078801
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cofinity Advantage |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna Medicare |
$32.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Advantage |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.09
|
| Rate for Payer: UHC Core |
$33.73
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UMR Bronson Commercial |
$23.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 51079078801
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cofinity Advantage |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.89
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UMR Bronson Commercial |
$0.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.79
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$2,035.02
|
|
|
Service Code
|
NDC 00009002901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$895.41 |
| Max. Negotiated Rate |
$1,831.52 |
| Rate for Payer: Aetna American Axle |
$1,322.76
|
| Rate for Payer: Aetna Commercial |
$1,729.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.76
|
| Rate for Payer: Cash Price |
$1,628.02
|
| Rate for Payer: Cofinity Advantage |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,750.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.02
|
| Rate for Payer: Healthscope Commercial |
$1,831.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,424.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.27
|
| Rate for Payer: PHP Commercial |
$1,729.77
|
| Rate for Payer: Priority Health SBD |
$1,282.06
|
| Rate for Payer: UMR Bronson Commercial |
$895.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.27
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$2,035.02
|
|
|
Service Code
|
NDC 00009002901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$752.96 |
| Max. Negotiated Rate |
$1,831.52 |
| Rate for Payer: Aetna American Axle |
$1,322.76
|
| Rate for Payer: Aetna Commercial |
$1,729.77
|
| Rate for Payer: Aetna Medicare |
$1,017.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.76
|
| Rate for Payer: BCBS Complete |
$814.01
|
| Rate for Payer: Cash Price |
$1,628.02
|
| Rate for Payer: Cofinity Advantage |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,750.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.02
|
| Rate for Payer: Healthscope Commercial |
$1,831.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,424.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,628.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.27
|
| Rate for Payer: PHP Commercial |
$1,729.77
|
| Rate for Payer: Priority Health SBD |
$1,282.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.76
|
| Rate for Payer: UHC Core |
$1,060.25
|
| Rate for Payer: UHC Exchange |
$799.76
|
| Rate for Payer: UMR Bronson Commercial |
$752.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.27
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Advantage |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Advantage |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$484.75
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.36 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna American Axle |
$315.09
|
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna Medicare |
$242.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.09
|
| Rate for Payer: UHC Core |
$252.55
|
| Rate for Payer: UHC Exchange |
$190.51
|
| Rate for Payer: UMR Bronson Commercial |
$179.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna American Axle |
$3.15
|
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$2.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.15
|
| Rate for Payer: BCBS Complete |
$1.94
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.88
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.64
|
| Rate for Payer: PHP Commercial |
$4.12
|
| Rate for Payer: Priority Health SBD |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.15
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Exchange |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.64
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$78.75
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
324
|
|
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
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
NDC 60687037711
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna American Axle |
$3.15
|
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.15
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.88
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.64
|
| Rate for Payer: PHP Commercial |
$4.12
|
| Rate for Payer: Priority Health SBD |
$3.06
|
| Rate for Payer: UMR Bronson Commercial |
$2.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.64
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 51079078820
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Advantage |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$484.75
|
|
|
Service Code
|
NDC 60687037701
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.29 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna American Axle |
$315.09
|
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
| Rate for Payer: UMR Bronson Commercial |
$213.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 59762371901
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna American Axle |
$35.26
|
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UMR Bronson Commercial |
$23.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.69
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Advantage |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.56
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.29
|
| Rate for Payer: UHC Core |
$48.32
|
| Rate for Payer: UHC Exchange |
$36.45
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.56
|
|
