|
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
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$250.85
|
|
|
Service Code
|
NDC 00555009696
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$225.76 |
| Rate for Payer: Aetna American Axle |
$163.05
|
| Rate for Payer: Aetna Commercial |
$213.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.05
|
| Rate for Payer: Cash Price |
$200.68
|
| Rate for Payer: Cofinity Commercial |
$175.59
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.68
|
| Rate for Payer: Healthscope Commercial |
$225.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.22
|
| Rate for Payer: PHP Commercial |
$213.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.05
|
| Rate for Payer: Priority Health SBD |
$158.04
|
| Rate for Payer: UMR Bronson Commercial |
$110.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.14
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$249.99
|
|
|
Service Code
|
NDC 00093929267
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$199.99
|
| Rate for Payer: Cofinity Commercial |
$174.99
|
| Rate for Payer: Cofinity Commercial |
$214.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.99
|
| Rate for Payer: Healthscope Commercial |
$224.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.49
|
| Rate for Payer: Priority Health SBD |
$157.49
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.99
|
|
|
Service Code
|
NDC 62332036606
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: Cash Price |
$199.99
|
| Rate for Payer: Cofinity Commercial |
$174.99
|
| Rate for Payer: Cofinity Commercial |
$214.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.99
|
| Rate for Payer: Healthscope Commercial |
$224.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.49
|
| Rate for Payer: Priority Health SBD |
$157.49
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$249.99
|
|
|
Service Code
|
NDC 62332036606
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$199.99
|
| Rate for Payer: Cofinity Commercial |
$174.99
|
| Rate for Payer: Cofinity Commercial |
$214.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.99
|
| Rate for Payer: Healthscope Commercial |
$224.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.49
|
| Rate for Payer: Priority Health SBD |
$157.49
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
NDC 00093929219
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna American Axle |
$2.71
|
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.71
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
NDC 00093929219
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna American Axle |
$2.71
|
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.99
|
|
|
Service Code
|
NDC 00093929267
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$224.99 |
| Rate for Payer: Aetna American Axle |
$162.49
|
| Rate for Payer: Aetna Commercial |
$212.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.49
|
| Rate for Payer: Cash Price |
$199.99
|
| Rate for Payer: Cofinity Commercial |
$174.99
|
| Rate for Payer: Cofinity Commercial |
$214.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.99
|
| Rate for Payer: Healthscope Commercial |
$224.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.49
|
| Rate for Payer: Priority Health SBD |
$157.49
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.49
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$250.85
|
|
|
Service Code
|
NDC 00555009696
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.81 |
| Max. Negotiated Rate |
$225.76 |
| Rate for Payer: Aetna American Axle |
$163.05
|
| Rate for Payer: Aetna Commercial |
$213.22
|
| Rate for Payer: Aetna Medicare |
$125.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.05
|
| Rate for Payer: BCBS Complete |
$100.34
|
| Rate for Payer: Cash Price |
$200.68
|
| Rate for Payer: Cofinity Commercial |
$175.59
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.68
|
| Rate for Payer: Healthscope Commercial |
$225.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.22
|
| Rate for Payer: PHP Commercial |
$213.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.05
|
| Rate for Payer: Priority Health SBD |
$158.04
|
| Rate for Payer: UMR Bronson Commercial |
$92.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.14
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$43.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna American Axle |
$28.44
|
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.44
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
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 Commercial |
$525.52
|
| Rate for Payer: Cofinity Commercial |
$645.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$525.52
|
| 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: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.99
|
| Rate for Payer: Priority Health SBD |
$472.97
|
| 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
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
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 Commercial |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.33
|
| 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: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$23.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$928.20
|
|
|
Service Code
|
NDC 00004006801
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.41 |
| Max. Negotiated Rate |
$835.38 |
| Rate for Payer: Aetna American Axle |
$603.33
|
| Rate for Payer: Aetna Commercial |
$788.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.33
|
| Rate for Payer: Cash Price |
$742.56
|
| Rate for Payer: Cofinity Commercial |
$649.74
|
| Rate for Payer: Cofinity Commercial |
$798.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.56
|
| Rate for Payer: Healthscope Commercial |
$835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.97
|
| Rate for Payer: PHP Commercial |
$788.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.33
|
| Rate for Payer: Priority Health SBD |
$584.77
|
| Rate for Payer: UMR Bronson Commercial |
$408.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.15
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 50268017311
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna American Axle |
$5.11
|
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$392.88
|
|
|
Service Code
|
NDC 50268017315
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.37 |
| Max. Negotiated Rate |
$353.59 |
| Rate for Payer: Aetna American Axle |
$255.37
|
| Rate for Payer: Aetna Commercial |
$333.95
|
| Rate for Payer: Aetna Medicare |
$196.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.37
|
| Rate for Payer: BCBS Complete |
$157.15
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: Cofinity Commercial |
$275.02
|
| Rate for Payer: Cofinity Commercial |
$337.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.30
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.95
|
| Rate for Payer: PHP Commercial |
$333.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.37
|
| Rate for Payer: Priority Health SBD |
$247.51
|
| Rate for Payer: UMR Bronson Commercial |
$145.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.66
|
|
|
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 Commercial |
$649.74
|
| Rate for Payer: Cofinity Commercial |
$798.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.56
|
| Rate for Payer: Healthscope Commercial |
$835.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.97
|
| Rate for Payer: PHP Commercial |
$788.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.33
|
| Rate for Payer: Priority Health SBD |
$584.77
|
| Rate for Payer: UMR Bronson Commercial |
$343.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.15
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna American Axle |
$28.44
|
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.44
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 50268017311
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna American Axle |
$5.11
|
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
NDC 16729013616
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UMR Bronson Commercial |
$92.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
NDC 00093083205
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$90.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
NDC 00093083205
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
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 Commercial |
$45.33
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.33
|
| 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: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| 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
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 72888015201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna American Axle |
$28.44
|
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.44
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health SBD |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
NDC 16729013616
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UMR Bronson Commercial |
$77.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
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 Commercial |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.26
|
| 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: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.88
|
| 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
|
|
