|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.99
|
|
|
Service Code
|
NDC 0093-9292-67
|
| 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: 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 Multiplan/Beech St/PHCS |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.99
|
| 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
|
IP
|
$250.85
|
|
|
Service Code
|
NDC 0555-0096-96
|
| 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 |
$215.73
|
| Rate for Payer: Cofinity Commercial |
$175.60
|
| 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 |
$175.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.22
|
| Rate for Payer: PHP Commercial |
$213.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.60
|
| 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
|
IP
|
$4.17
|
|
|
Service Code
|
NDC 0093-9292-19
|
| 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: 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 Multiplan/Beech St/PHCS |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| 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
|
IP
|
$249.99
|
|
|
Service Code
|
NDC 62332-366-06
|
| 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: 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 Multiplan/Beech St/PHCS |
$212.49
|
| Rate for Payer: PHP Commercial |
$212.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.99
|
| 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 TABLET
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
NDC 0093-0832-05
|
| 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: 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 Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| 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 16729-136-00
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.28 |
| 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 |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| 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
|
$928.20
|
|
|
Service Code
|
NDC 0004-0068-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$788.97
|
| Rate for Payer: PHP Commercial |
$788.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.74
|
| 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
|
$7.18
|
|
|
Service Code
|
NDC 60687-544-11
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna American Axle |
$4.67
|
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.67
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$5.03
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.10
|
| Rate for Payer: PHP Commercial |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 43547-406-10
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.28 |
| 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 |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| 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
|
$288.75
|
|
|
Service Code
|
NDC 16729-136-16
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$259.88 |
| Rate for Payer: Aetna American Axle |
$187.69
|
| Rate for Payer: Aetna Commercial |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.69
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cofinity Commercial |
$202.12
|
| Rate for Payer: Cofinity Commercial |
$248.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.00
|
| Rate for Payer: Healthscope Commercial |
$259.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.44
|
| Rate for Payer: PHP Commercial |
$245.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.12
|
| Rate for Payer: Priority Health SBD |
$181.91
|
| Rate for Payer: UMR Bronson Commercial |
$127.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.56
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 63739-263-10
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.58
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$717.50
|
|
|
Service Code
|
NDC 60687-544-01
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.70 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Aetna American Axle |
$466.38
|
| Rate for Payer: Aetna Commercial |
$609.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.38
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$502.25
|
| Rate for Payer: Cofinity Commercial |
$617.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Healthscope Commercial |
$645.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$609.88
|
| Rate for Payer: PHP Commercial |
$609.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.25
|
| Rate for Payer: Priority Health SBD |
$452.02
|
| Rate for Payer: UMR Bronson Commercial |
$315.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.12
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
NDC 43547-407-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| 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
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 16729-137-00
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 51079-882-20
|
| 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: 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 Multiplan/Beech St/PHCS |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| 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
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 51079-882-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$1.25
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| 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
|
$717.50
|
|
|
Service Code
|
NDC 60687-555-01
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.70 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Aetna American Axle |
$466.38
|
| Rate for Payer: Aetna Commercial |
$609.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.38
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$502.25
|
| Rate for Payer: Cofinity Commercial |
$617.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Healthscope Commercial |
$645.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$502.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$609.88
|
| Rate for Payer: PHP Commercial |
$609.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.25
|
| Rate for Payer: Priority Health SBD |
$452.02
|
| Rate for Payer: UMR Bronson Commercial |
$315.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.12
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
NDC 60687-555-11
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna American Axle |
$4.67
|
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.67
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cofinity Commercial |
$5.03
|
| Rate for Payer: Cofinity Commercial |
$6.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$6.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.10
|
| Rate for Payer: PHP Commercial |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$3.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.38
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$29.67
|
|
|
Service Code
|
NDC 0378-0871-16
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: Aetna American Axle |
$19.29
|
| Rate for Payer: Aetna Commercial |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.29
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Cofinity Commercial |
$25.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.22
|
| Rate for Payer: PHP Commercial |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.77
|
| Rate for Payer: Priority Health SBD |
$18.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.25
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$118.67
|
|
|
Service Code
|
NDC 0378-0871-99
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$106.80 |
| Rate for Payer: Aetna American Axle |
$77.14
|
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.14
|
| Rate for Payer: Cash Price |
$94.94
|
| Rate for Payer: Cofinity Commercial |
$102.06
|
| Rate for Payer: Cofinity Commercial |
$83.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.94
|
| Rate for Payer: Healthscope Commercial |
$106.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.87
|
| Rate for Payer: PHP Commercial |
$100.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.07
|
| Rate for Payer: Priority Health SBD |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.00
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$360.80
|
|
|
Service Code
|
NDC 0591-3508-04
|
| 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: 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 Multiplan/Beech St/PHCS |
$306.68
|
| Rate for Payer: PHP Commercial |
$306.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.56
|
| 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
|
IP
|
$198.44
|
|
|
Service Code
|
NDC 0378-0872-99
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna American Axle |
$128.99
|
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.67
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.91
|
| Rate for Payer: Priority Health SBD |
$125.02
|
| Rate for Payer: UMR Bronson Commercial |
$87.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.83
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna American Axle |
$32.25
|
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.25
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$34.73
|
| Rate for Payer: Cofinity Commercial |
$42.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.17
|
| Rate for Payer: PHP Commercial |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.73
|
| Rate for Payer: Priority Health SBD |
$31.25
|
| Rate for Payer: UMR Bronson Commercial |
$21.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.21
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,681.65
|
|
|
Service Code
|
NDC 0597-0032-34
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$739.93 |
| 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 New Business (MI Preferred) |
$1,093.07
|
| Rate for Payer: Cash Price |
$1,345.32
|
| Rate for Payer: Cofinity Commercial |
$1,177.16
|
| Rate for Payer: Cofinity Commercial |
$1,446.22
|
| 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 |
$1,177.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,261.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,429.40
|
| Rate for Payer: PHP Commercial |
$1,429.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.16
|
| Rate for Payer: Priority Health SBD |
$1,059.44
|
| Rate for Payer: UMR Bronson Commercial |
$739.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,261.24
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$254.64
|
|
|
Service Code
|
NDC 0378-0873-99
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$229.18 |
| Rate for Payer: Aetna American Axle |
$165.52
|
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.52
|
| Rate for Payer: Cash Price |
$203.71
|
| Rate for Payer: Cofinity Commercial |
$178.25
|
| Rate for Payer: Cofinity Commercial |
$218.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.71
|
| Rate for Payer: Healthscope Commercial |
$229.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.25
|
| Rate for Payer: Priority Health SBD |
$160.42
|
| Rate for Payer: UMR Bronson Commercial |
$112.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.98
|
|
