|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$392.88
|
|
|
Service Code
|
NDC 50268017315
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.87 |
| Max. Negotiated Rate |
$353.59 |
| Rate for Payer: Aetna American Axle |
$255.37
|
| Rate for Payer: Aetna Commercial |
$333.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.37
|
| 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 |
$172.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.66
|
|
|
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
|
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
|
$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 1 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$301.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
NDC 00904772861
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$253.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna American Axle |
$4.94
|
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.94
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 51079088220
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.25
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.25
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna American Axle |
$493.68
|
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna Medicare |
$379.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.68
|
| Rate for Payer: BCBS Complete |
$303.80
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health SBD |
$478.49
|
| Rate for Payer: UMR Bronson Commercial |
$281.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna American Axle |
$493.68
|
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.68
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health SBD |
$478.49
|
| Rate for Payer: UMR Bronson Commercial |
$334.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.25
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.96
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 51079088220
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna American Axle |
$54.60
|
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.60
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UMR Bronson Commercial |
$31.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna American Axle |
$54.60
|
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UMR Bronson Commercial |
$36.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
NDC 16729013700
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
NDC 16729013700
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna American Axle |
$4.94
|
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.94
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$5.32
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$360.80
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.50 |
| Max. Negotiated Rate |
$324.72 |
| Rate for Payer: Aetna American Axle |
$234.52
|
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: Aetna Medicare |
$180.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.52
|
| Rate for Payer: BCBS Complete |
$144.32
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cofinity Commercial |
$252.56
|
| Rate for Payer: Cofinity Commercial |
$310.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.64
|
| Rate for Payer: Healthscope Commercial |
$324.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.68
|
| Rate for Payer: PHP Commercial |
$306.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.52
|
| Rate for Payer: Priority Health SBD |
$227.30
|
| Rate for Payer: UMR Bronson Commercial |
$133.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.60
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$91.18
|
|
|
Service Code
|
NDC 00378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna American Axle |
$59.27
|
| Rate for Payer: Aetna Commercial |
$77.50
|
| Rate for Payer: Aetna Medicare |
$45.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.27
|
| Rate for Payer: BCBS Complete |
$36.47
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$63.83
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: PHP Commercial |
$77.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health SBD |
$57.44
|
| Rate for Payer: UMR Bronson Commercial |
$33.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.39
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$91.18
|
|
|
Service Code
|
NDC 00378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna American Axle |
$59.27
|
| Rate for Payer: Aetna Commercial |
$77.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.27
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$63.83
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: PHP Commercial |
$77.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health SBD |
$57.44
|
| Rate for Payer: UMR Bronson Commercial |
$40.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.39
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$364.72
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Commercial |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$313.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UMR Bronson Commercial |
$160.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$364.72
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna Medicare |
$182.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Commercial |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$313.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UMR Bronson Commercial |
$134.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$360.80
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$324.72 |
| Rate for Payer: Aetna American Axle |
$234.52
|
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.52
|
| Rate for Payer: Cash Price |
$288.64
|
| Rate for Payer: Cofinity Commercial |
$252.56
|
| Rate for Payer: Cofinity Commercial |
$310.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.64
|
| Rate for Payer: Healthscope Commercial |
$324.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.68
|
| Rate for Payer: PHP Commercial |
$306.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.52
|
| Rate for Payer: Priority Health SBD |
$227.30
|
| Rate for Payer: UMR Bronson Commercial |
$158.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.60
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,681.65
|
|
|
Service Code
|
NDC 00597003234
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.21 |
| Max. Negotiated Rate |
$1,513.48 |
| Rate for Payer: Aetna American Axle |
$1,093.07
|
| Rate for Payer: Aetna Commercial |
$1,429.40
|
| Rate for Payer: Aetna Medicare |
$840.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.07
|
| Rate for Payer: BCBS Complete |
$672.66
|
| Rate for Payer: Cash Price |
$1,345.32
|
| Rate for Payer: Cofinity Commercial |
$1,177.15
|
| Rate for Payer: Cofinity Commercial |
$1,446.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,177.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,345.32
|
| Rate for Payer: Healthscope Commercial |
$1,513.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,177.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,261.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,429.40
|
| Rate for Payer: PHP Commercial |
$1,429.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.07
|
| Rate for Payer: Priority Health SBD |
$1,059.44
|
| Rate for Payer: UMR Bronson Commercial |
$622.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,261.24
|
|
