|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$52.61
|
|
|
Service Code
|
NDC 00168016315
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna American Axle |
$34.20
|
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Medicare |
$26.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: BCBS Complete |
$21.04
|
| Rate for Payer: Cash Price |
$42.09
|
| Rate for Payer: Cofinity Commercial |
$36.83
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$47.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.72
|
| Rate for Payer: PHP Commercial |
$44.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.20
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UMR Bronson Commercial |
$19.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.46
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.71
|
|
|
Service Code
|
NDC 52565005115
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna American Axle |
$21.26
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.53
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.55
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna American Axle |
$13.56
|
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.56
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.56
|
| Rate for Payer: Priority Health SBD |
$13.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$78.12
|
|
|
Service Code
|
NDC 00713065615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Aetna American Axle |
$50.78
|
| Rate for Payer: Aetna Commercial |
$66.40
|
| Rate for Payer: Aetna Medicare |
$39.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.78
|
| Rate for Payer: BCBS Complete |
$31.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$54.68
|
| Rate for Payer: Cofinity Commercial |
$67.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$70.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.40
|
| Rate for Payer: PHP Commercial |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.78
|
| Rate for Payer: Priority Health SBD |
$49.22
|
| Rate for Payer: UMR Bronson Commercial |
$28.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.59
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$78.12
|
|
|
Service Code
|
NDC 00713065615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Aetna American Axle |
$50.78
|
| Rate for Payer: Aetna Commercial |
$66.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.78
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$54.68
|
| Rate for Payer: Cofinity Commercial |
$67.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$70.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.40
|
| Rate for Payer: PHP Commercial |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.78
|
| Rate for Payer: Priority Health SBD |
$49.22
|
| Rate for Payer: UMR Bronson Commercial |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.59
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.86
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna American Axle |
$13.56
|
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.56
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.56
|
| Rate for Payer: Priority Health SBD |
$13.14
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 70700010615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UMR Bronson Commercial |
$17.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 70700010615
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UMR Bronson Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.86
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna American Axle |
$13.56
|
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.56
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$18.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.73
|
| Rate for Payer: PHP Commercial |
$17.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.56
|
| Rate for Payer: Priority Health SBD |
$13.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.64
|
|
|
CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,324.66
|
|
|
Service Code
|
HCPCS J9027
|
| Hospital Charge Code |
40404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2,092.19 |
| Rate for Payer: Aetna American Axle |
$1,511.03
|
| Rate for Payer: Aetna American Axle |
$964.08
|
| Rate for Payer: Aetna American Axle |
$651.43
|
| Rate for Payer: Aetna Commercial |
$1,975.96
|
| Rate for Payer: Aetna Commercial |
$851.87
|
| Rate for Payer: Aetna Commercial |
$1,260.72
|
| Rate for Payer: Aetna Medicare |
$4.36
|
| Rate for Payer: Aetna Medicare |
$4.36
|
| Rate for Payer: Aetna Medicare |
$4.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.24
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cofinity Commercial |
$701.54
|
| Rate for Payer: Cofinity Commercial |
$1,999.21
|
| Rate for Payer: Cofinity Commercial |
$1,627.26
|
| Rate for Payer: Cofinity Commercial |
$1,038.24
|
| Rate for Payer: Cofinity Commercial |
$861.89
|
| Rate for Payer: Cofinity Commercial |
$1,275.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,627.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$701.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Healthscope Commercial |
$901.98
|
| Rate for Payer: Healthscope Commercial |
$2,092.19
|
| Rate for Payer: Healthscope Commercial |
$1,334.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,627.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.40
|
| Rate for Payer: Mclaren Medicaid |
$2.25
|
| Rate for Payer: Mclaren Medicaid |
$2.25
|
| Rate for Payer: Mclaren Medicaid |
$2.25
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,975.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.87
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PHP Commercial |
$1,975.96
|
| Rate for Payer: PHP Commercial |
$851.87
|
| Rate for Payer: PHP Commercial |
$1,260.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.43
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health SBD |
$631.39
|
| Rate for Payer: Priority Health SBD |
$934.42
|
| Rate for Payer: Priority Health SBD |
$1,464.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Exchange |
$8.01
|
| Rate for Payer: UHC Exchange |
$8.01
|
| Rate for Payer: UHC Exchange |
$8.01
|
| Rate for Payer: UHC Medicare Advantage |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.19
|
| Rate for Payer: UHCCP Medicaid |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$2.25
|
| Rate for Payer: UMR Bronson Commercial |
$548.78
|
| Rate for Payer: UMR Bronson Commercial |
$860.12
|
| Rate for Payer: UMR Bronson Commercial |
$370.81
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: VA VA |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.65
|
|
|
CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,002.20
|
|
|
Service Code
|
HCPCS J9027
|
| Hospital Charge Code |
40404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.97 |
| Max. Negotiated Rate |
$901.98 |
| Rate for Payer: Aetna American Axle |
$651.43
|
| Rate for Payer: Aetna American Axle |
$964.08
|
| Rate for Payer: Aetna American Axle |
$1,511.03
|
| Rate for Payer: Aetna Commercial |
$1,260.72
|
| Rate for Payer: Aetna Commercial |
$851.87
|
| Rate for Payer: Aetna Commercial |
$1,975.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.08
|
| Rate for Payer: Cash Price |
$1,859.73
|
| Rate for Payer: Cash Price |
$1,186.56
|
| Rate for Payer: Cash Price |
$801.76
|
| Rate for Payer: Cofinity Commercial |
$861.89
|
| Rate for Payer: Cofinity Commercial |
$1,275.55
|
| Rate for Payer: Cofinity Commercial |
$1,038.24
|
| Rate for Payer: Cofinity Commercial |
$1,999.21
|
| Rate for Payer: Cofinity Commercial |
$1,627.26
|
| Rate for Payer: Cofinity Commercial |
$701.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$701.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,627.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.56
|
| Rate for Payer: Healthscope Commercial |
$1,334.88
|
| Rate for Payer: Healthscope Commercial |
$901.98
|
| Rate for Payer: Healthscope Commercial |
$2,092.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,627.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,112.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,975.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.72
|
| Rate for Payer: PHP Commercial |
$1,975.96
|
| Rate for Payer: PHP Commercial |
$1,260.72
|
| Rate for Payer: PHP Commercial |
$851.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.43
|
| Rate for Payer: Priority Health SBD |
$1,464.54
|
| Rate for Payer: Priority Health SBD |
$934.42
|
| Rate for Payer: Priority Health SBD |
$631.39
|
| Rate for Payer: UMR Bronson Commercial |
$440.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,022.85
|
| Rate for Payer: UMR Bronson Commercial |
$652.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,112.40
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 51672401105
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
NDC 51672401106
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 51672401105
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$88.35
|
|
|
Service Code
|
NDC 16571068303
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna Medicare |
$44.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$88.35
|
|
|
Service Code
|
NDC 42571034230
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
OP
|
$88.35
|
|
|
Service Code
|
NDC 42571034230
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna Medicare |
$44.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
NDC 51672401106
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
CLOMIPRAMINE 25 MG CAPSULE
|
Facility
|
IP
|
$88.35
|
|
|
Service Code
|
NDC 16571068303
|
| Hospital Charge Code |
9635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 49884030652
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 49884030602
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.53
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.99
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$261.22
|
|
|
Service Code
|
NDC 57664078386
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$235.10 |
| Rate for Payer: Aetna American Axle |
$169.79
|
| Rate for Payer: Aetna Commercial |
$222.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.79
|
| Rate for Payer: Cash Price |
$208.98
|
| Rate for Payer: Cofinity Commercial |
$182.85
|
| Rate for Payer: Cofinity Commercial |
$224.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.98
|
| Rate for Payer: Healthscope Commercial |
$235.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.04
|
| Rate for Payer: PHP Commercial |
$222.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.79
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.91
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$261.22
|
|
|
Service Code
|
NDC 57664078386
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$235.10 |
| Rate for Payer: Aetna American Axle |
$169.79
|
| Rate for Payer: Aetna Commercial |
$222.04
|
| Rate for Payer: Aetna Medicare |
$130.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.79
|
| Rate for Payer: BCBS Complete |
$104.49
|
| Rate for Payer: Cash Price |
$208.98
|
| Rate for Payer: Cofinity Commercial |
$182.85
|
| Rate for Payer: Cofinity Commercial |
$224.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.98
|
| Rate for Payer: Healthscope Commercial |
$235.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.04
|
| Rate for Payer: PHP Commercial |
$222.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.79
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: UMR Bronson Commercial |
$96.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.91
|
|
|
CLONAZEPAM 0.125 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 49884030652
|
| Hospital Charge Code |
35625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
