|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$750.75
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.30 |
| Max. Negotiated Rate |
$675.68 |
| Rate for Payer: Aetna Commercial |
$638.14
|
| Rate for Payer: Aetna Medicare |
$195.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.61
|
| Rate for Payer: BCBS Complete |
$300.30
|
| Rate for Payer: BCBS MAPPO |
$187.69
|
| Rate for Payer: BCBS Trust/PPO |
$617.19
|
| Rate for Payer: BCN Commercial |
$583.71
|
| Rate for Payer: BCN Medicare Advantage |
$187.69
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cofinity Commercial |
$645.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.69
|
| Rate for Payer: Healthscope Commercial |
$675.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.14
|
| Rate for Payer: Nomi Health Commercial |
$615.62
|
| Rate for Payer: PACE Senior Care Partners |
$178.30
|
| Rate for Payer: PACE SWMI |
$187.69
|
| Rate for Payer: PHP Commercial |
$638.14
|
| Rate for Payer: PHP Medicare Advantage |
$187.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.99
|
| Rate for Payer: Priority Health HMO/PPO |
$653.15
|
| Rate for Payer: Priority Health Medicare |
$189.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.00
|
| Rate for Payer: Railroad Medicare Medicare |
$187.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.66
|
| Rate for Payer: UHC Core |
$626.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.69
|
| Rate for Payer: UHC Exchange |
$187.69
|
| Rate for Payer: UHC Medicare Advantage |
$187.69
|
| Rate for Payer: VA VA |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.06
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$43.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.67
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: BCBS MAPPO |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$35.97
|
| Rate for Payer: BCN Commercial |
$34.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.94
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.19
|
| Rate for Payer: Nomi Health Commercial |
$35.88
|
| Rate for Payer: PACE Senior Care Partners |
$10.39
|
| Rate for Payer: PACE SWMI |
$10.94
|
| Rate for Payer: PHP Commercial |
$37.19
|
| Rate for Payer: PHP Medicare Advantage |
$10.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.44
|
| Rate for Payer: Priority Health HMO/PPO |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$11.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.31
|
| Rate for Payer: Railroad Medicare Medicare |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.50
|
| Rate for Payer: UHC Core |
$36.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.94
|
| Rate for Payer: UHC Exchange |
$10.94
|
| Rate for Payer: UHC Medicare Advantage |
$10.94
|
| Rate for Payer: VA VA |
$10.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.81
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$6.13
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Nomi Health Commercial |
$6.16
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.88
|
| Rate for Payer: Priority Health HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.61
|
| Rate for Payer: UHC Core |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$7.51
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.38
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.35
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.84
|
| Rate for Payer: BCN Medicare Advantage |
$1.88
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$6.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.38
|
| Rate for Payer: Nomi Health Commercial |
$6.16
|
| Rate for Payer: PACE Senior Care Partners |
$1.78
|
| Rate for Payer: PACE SWMI |
$1.88
|
| Rate for Payer: PHP Commercial |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.88
|
| Rate for Payer: Priority Health HMO/PPO |
$6.53
|
| Rate for Payer: Priority Health Medicare |
$1.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.61
|
| Rate for Payer: UHC Core |
$6.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.88
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
| Rate for Payer: VA VA |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.63
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.38
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.25
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: BCN Medicare Advantage |
$1.90
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.80
|
| Rate for Payer: PACE SWMI |
$1.90
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$759.50
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.38 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: Aetna Medicare |
$197.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.34
|
| Rate for Payer: BCBS Complete |
$303.80
|
| Rate for Payer: BCBS MAPPO |
$189.88
|
| Rate for Payer: BCBS Trust/PPO |
$624.38
|
| Rate for Payer: BCN Commercial |
$590.51
|
| Rate for Payer: BCN Medicare Advantage |
$189.88
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.88
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Nomi Health Commercial |
$622.79
|
| Rate for Payer: PACE Senior Care Partners |
$180.38
|
| Rate for Payer: PACE SWMI |
$189.88
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: PHP Medicare Advantage |
$189.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Medicare |
$191.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$508.86
|
| Rate for Payer: Railroad Medicare Medicare |
$189.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.36
|
| Rate for Payer: UHC Core |
$634.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.88
|
| Rate for Payer: UHC Exchange |
$189.88
|
| Rate for Payer: UHC Medicare Advantage |
$189.88
|
| Rate for Payer: VA VA |
$189.88
|
| 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 |
$493.68 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$645.58
|
| Rate for Payer: BCBS Trust/PPO |
$619.98
|
| Rate for Payer: BCN Commercial |
$586.94
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cofinity Commercial |
$653.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.60
|
| Rate for Payer: Healthscope Commercial |
$683.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.58
|
| Rate for Payer: Nomi Health Commercial |
$622.79
|
| Rate for Payer: PHP Commercial |
$645.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health HMO/PPO |
$660.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$508.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.36
|
| Rate for Payer: UHC Core |
$634.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.62
|
|
|
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 |
$59.27 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna Commercial |
$77.50
|
| Rate for Payer: BCBS Trust/PPO |
$74.43
|
| Rate for Payer: BCN Commercial |
$70.46
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$74.77
|
| Rate for Payer: PHP Commercial |
$77.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health HMO/PPO |
$79.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.24
|
| Rate for Payer: UHC Core |
$76.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.38
|
|
|
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 |
$21.66 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna Commercial |
$77.50
|
| Rate for Payer: Aetna Medicare |
$23.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.49
|
| Rate for Payer: BCBS Complete |
$36.47
|
| Rate for Payer: BCBS MAPPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$74.96
|
| Rate for Payer: BCN Commercial |
$70.89
|
| Rate for Payer: BCN Medicare Advantage |
$22.80
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.80
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$74.77
|
| Rate for Payer: PACE Senior Care Partners |
$21.66
|
| Rate for Payer: PACE SWMI |
$22.80
|
| Rate for Payer: PHP Commercial |
$77.50
|
| Rate for Payer: PHP Medicare Advantage |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health HMO/PPO |
$79.33
|
| Rate for Payer: Priority Health Medicare |
$23.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.24
|
| Rate for Payer: UHC Core |
$76.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.80
|
| Rate for Payer: UHC Exchange |
$22.80
|
| Rate for Payer: UHC Medicare Advantage |
$22.80
|
| Rate for Payer: VA VA |
$22.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.38
|
|
|
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 |
$86.62 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna Medicare |
$94.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.98
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: BCBS MAPPO |
$91.18
|
| Rate for Payer: BCBS Trust/PPO |
$299.84
|
| Rate for Payer: BCN Commercial |
$283.57
|
| Rate for Payer: BCN Medicare Advantage |
$91.18
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Commercial |
$313.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.18
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Nomi Health Commercial |
$299.07
|
| Rate for Payer: PACE Senior Care Partners |
$86.62
|
| Rate for Payer: PACE SWMI |
$91.18
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: PHP Medicare Advantage |
$91.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: Priority Health HMO/PPO |
$317.31
|
| Rate for Payer: Priority Health Medicare |
$92.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: Railroad Medicare Medicare |
$91.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.95
|
| Rate for Payer: UHC Core |
$304.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.18
|
| Rate for Payer: UHC Exchange |
$91.18
|
| Rate for Payer: UHC Medicare Advantage |
$91.18
|
| Rate for Payer: VA VA |
$91.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$56.76
|
|
|
Service Code
|
NDC 00555100901
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.25
|
| Rate for Payer: Aetna Medicare |
$14.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.74
|
| Rate for Payer: BCBS Complete |
$22.70
|
| Rate for Payer: BCBS MAPPO |
$14.19
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$44.13
|
| Rate for Payer: BCN Medicare Advantage |
$14.19
|
| Rate for Payer: Cash Price |
$45.41
|
| Rate for Payer: Cofinity Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.25
|
| Rate for Payer: Nomi Health Commercial |
$46.54
|
| Rate for Payer: PACE Senior Care Partners |
$13.48
|
| Rate for Payer: PACE SWMI |
$14.19
|
| Rate for Payer: PHP Commercial |
$48.25
|
| Rate for Payer: PHP Medicare Advantage |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.89
|
| Rate for Payer: Priority Health HMO/PPO |
$49.38
|
| Rate for Payer: Priority Health Medicare |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.03
|
| Rate for Payer: Railroad Medicare Medicare |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.95
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.19
|
| Rate for Payer: UHC Exchange |
$14.19
|
| Rate for Payer: UHC Medicare Advantage |
$14.19
|
| Rate for Payer: VA VA |
$14.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.57
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$56.76
|
|
|
Service Code
|
NDC 00555100901
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.25
|
| Rate for Payer: BCBS Trust/PPO |
$46.33
|
| Rate for Payer: BCN Commercial |
$43.86
|
| Rate for Payer: Cash Price |
$45.41
|
| Rate for Payer: Cofinity Commercial |
$48.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.41
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.25
|
| Rate for Payer: Nomi Health Commercial |
$46.54
|
| Rate for Payer: PHP Commercial |
$48.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.89
|
| Rate for Payer: Priority Health HMO/PPO |
$49.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.95
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.57
|
|
|
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 |
$237.07 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: BCBS Trust/PPO |
$297.72
|
| Rate for Payer: BCN Commercial |
$281.86
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Commercial |
$313.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Nomi Health Commercial |
$299.07
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: Priority Health HMO/PPO |
$317.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.95
|
| Rate for Payer: UHC Core |
$304.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$153.52
|
|
|
Service Code
|
NDC 00378087216
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$138.17 |
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: BCBS Trust/PPO |
$125.32
|
| Rate for Payer: BCN Commercial |
$118.64
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Healthscope Commercial |
$138.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PHP Commercial |
$130.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.10
|
| Rate for Payer: UHC Core |
$128.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.14
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$153.52
|
|
|
Service Code
|
NDC 00378087216
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$138.17 |
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: Aetna Medicare |
$39.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.98
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS MAPPO |
$38.38
|
| Rate for Payer: BCBS Trust/PPO |
$126.21
|
| Rate for Payer: BCN Commercial |
$119.36
|
| Rate for Payer: BCN Medicare Advantage |
$38.38
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.38
|
| Rate for Payer: Healthscope Commercial |
$138.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PACE Senior Care Partners |
$36.46
|
| Rate for Payer: PACE SWMI |
$38.38
|
| Rate for Payer: PHP Commercial |
$130.49
|
| Rate for Payer: PHP Medicare Advantage |
$38.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.56
|
| Rate for Payer: Priority Health Medicare |
$38.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.10
|
| Rate for Payer: UHC Core |
$128.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.38
|
| Rate for Payer: UHC Exchange |
$38.38
|
| Rate for Payer: UHC Medicare Advantage |
$38.38
|
| Rate for Payer: VA VA |
$38.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.14
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$614.06
|
|
|
Service Code
|
NDC 00378087299
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.84 |
| Max. Negotiated Rate |
$552.65 |
| Rate for Payer: Aetna Commercial |
$521.95
|
| Rate for Payer: Aetna Medicare |
$159.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.89
|
| Rate for Payer: BCBS Complete |
$245.62
|
| Rate for Payer: BCBS MAPPO |
$153.52
|
| Rate for Payer: BCBS Trust/PPO |
$504.82
|
| Rate for Payer: BCN Commercial |
$477.43
|
| Rate for Payer: BCN Medicare Advantage |
$153.52
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cofinity Commercial |
$528.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.52
|
| Rate for Payer: Healthscope Commercial |
$552.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.95
|
| Rate for Payer: Nomi Health Commercial |
$503.53
|
| Rate for Payer: PACE Senior Care Partners |
$145.84
|
| Rate for Payer: PACE SWMI |
$153.52
|
| Rate for Payer: PHP Commercial |
$521.95
|
| Rate for Payer: PHP Medicare Advantage |
$153.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.14
|
| Rate for Payer: Priority Health HMO/PPO |
$534.23
|
| Rate for Payer: Priority Health Medicare |
$155.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.42
|
| Rate for Payer: Railroad Medicare Medicare |
$153.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.37
|
| Rate for Payer: UHC Core |
$512.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.52
|
| Rate for Payer: UHC Exchange |
$153.52
|
| Rate for Payer: UHC Medicare Advantage |
$153.52
|
| Rate for Payer: VA VA |
$153.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.54
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$614.06
|
|
|
Service Code
|
NDC 00378087299
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.14 |
| Max. Negotiated Rate |
$552.65 |
| Rate for Payer: Aetna Commercial |
$521.95
|
| Rate for Payer: BCBS Trust/PPO |
$501.26
|
| Rate for Payer: BCN Commercial |
$474.55
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cofinity Commercial |
$528.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.25
|
| Rate for Payer: Healthscope Commercial |
$552.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.95
|
| Rate for Payer: Nomi Health Commercial |
$503.53
|
| Rate for Payer: PHP Commercial |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.14
|
| Rate for Payer: Priority Health HMO/PPO |
$534.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.37
|
| Rate for Payer: UHC Core |
$512.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.54
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$212.97
|
|
|
Service Code
|
NDC 00378087316
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.43 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$181.02
|
| Rate for Payer: BCBS Trust/PPO |
$173.85
|
| Rate for Payer: BCN Commercial |
$164.58
|
| Rate for Payer: Cash Price |
$170.38
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.38
|
| Rate for Payer: Healthscope Commercial |
$191.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.02
|
| Rate for Payer: Nomi Health Commercial |
$174.64
|
| Rate for Payer: PHP Commercial |
$181.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.43
|
| Rate for Payer: Priority Health HMO/PPO |
$185.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.41
|
| Rate for Payer: UHC Core |
$177.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.73
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$851.86
|
|
|
Service Code
|
NDC 00378087399
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$553.71 |
| Max. Negotiated Rate |
$766.67 |
| Rate for Payer: Aetna Commercial |
$724.08
|
| Rate for Payer: BCBS Trust/PPO |
$695.37
|
| Rate for Payer: BCN Commercial |
$658.32
|
| Rate for Payer: Cash Price |
$681.49
|
| Rate for Payer: Cofinity Commercial |
$732.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.49
|
| Rate for Payer: Healthscope Commercial |
$766.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.08
|
| Rate for Payer: Nomi Health Commercial |
$698.53
|
| Rate for Payer: PHP Commercial |
$724.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.71
|
| Rate for Payer: Priority Health HMO/PPO |
$741.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.64
|
| Rate for Payer: UHC Core |
$711.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.90
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$851.86
|
|
|
Service Code
|
NDC 00378087399
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.32 |
| Max. Negotiated Rate |
$766.67 |
| Rate for Payer: Aetna Commercial |
$724.08
|
| Rate for Payer: Aetna Medicare |
$221.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$266.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$266.21
|
| Rate for Payer: BCBS Complete |
$340.74
|
| Rate for Payer: BCBS MAPPO |
$212.96
|
| Rate for Payer: BCBS Trust/PPO |
$700.31
|
| Rate for Payer: BCN Commercial |
$662.32
|
| Rate for Payer: BCN Medicare Advantage |
$212.96
|
| Rate for Payer: Cash Price |
$681.49
|
| Rate for Payer: Cofinity Commercial |
$732.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.96
|
| Rate for Payer: Healthscope Commercial |
$766.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.08
|
| Rate for Payer: Nomi Health Commercial |
$698.53
|
| Rate for Payer: PACE Senior Care Partners |
$202.32
|
| Rate for Payer: PACE SWMI |
$212.96
|
| Rate for Payer: PHP Commercial |
$724.08
|
| Rate for Payer: PHP Medicare Advantage |
$212.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.71
|
| Rate for Payer: Priority Health HMO/PPO |
$741.12
|
| Rate for Payer: Priority Health Medicare |
$215.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.75
|
| Rate for Payer: Railroad Medicare Medicare |
$212.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.64
|
| Rate for Payer: UHC Core |
$711.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.96
|
| Rate for Payer: UHC Exchange |
$212.96
|
| Rate for Payer: UHC Medicare Advantage |
$212.96
|
| Rate for Payer: VA VA |
$212.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.90
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$212.97
|
|
|
Service Code
|
NDC 00378087316
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.58 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$181.02
|
| Rate for Payer: Aetna Medicare |
$55.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.55
|
| Rate for Payer: BCBS Complete |
$85.19
|
| Rate for Payer: BCBS MAPPO |
$53.24
|
| Rate for Payer: BCBS Trust/PPO |
$175.08
|
| Rate for Payer: BCN Commercial |
$165.58
|
| Rate for Payer: BCN Medicare Advantage |
$53.24
|
| Rate for Payer: Cash Price |
$170.38
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.24
|
| Rate for Payer: Healthscope Commercial |
$191.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.02
|
| Rate for Payer: Nomi Health Commercial |
$174.64
|
| Rate for Payer: PACE Senior Care Partners |
$50.58
|
| Rate for Payer: PACE SWMI |
$53.24
|
| Rate for Payer: PHP Commercial |
$181.02
|
| Rate for Payer: PHP Medicare Advantage |
$53.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.43
|
| Rate for Payer: Priority Health HMO/PPO |
$185.28
|
| Rate for Payer: Priority Health Medicare |
$53.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.69
|
| Rate for Payer: Railroad Medicare Medicare |
$53.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.41
|
| Rate for Payer: UHC Core |
$177.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.24
|
| Rate for Payer: UHC Exchange |
$53.24
|
| Rate for Payer: UHC Medicare Advantage |
$53.24
|
| Rate for Payer: VA VA |
$53.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.73
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$70.83
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.64
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: BCBS MAPPO |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.35
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: BCN Medicare Advantage |
$22.91
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PACE Senior Care Partners |
$21.77
|
| Rate for Payer: PACE SWMI |
$22.91
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: Railroad Medicare Medicare |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.91
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicare Advantage |
$22.91
|
| Rate for Payer: VA VA |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
