|
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
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$233.42
|
| Rate for Payer: BCN Commercial |
$220.98
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.36
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$222.33
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PACE Senior Care Partners |
$67.91
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.49
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| Rate for Payer: VA VA |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$105.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.31
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCN Commercial |
$314.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.05
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.05
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: PACE Senior Care Partners |
$96.00
|
| Rate for Payer: PACE SWMI |
$101.05
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.81
|
| Rate for Payer: Railroad Medicare Medicare |
$101.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.05
|
| Rate for Payer: UHC Exchange |
$101.05
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: VA VA |
$101.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: BCBS Trust/PPO |
$329.95
|
| Rate for Payer: BCN Commercial |
$312.37
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION
|
Facility
|
OP
|
$1,190.46
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.70 |
| Max. Negotiated Rate |
$1,190.46 |
| Rate for Payer: BCBS Complete |
$1,190.46
|
| Rate for Payer: Mclaren Medicaid |
$1,133.70
|
| Rate for Payer: Meridian Medicaid |
$1,190.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.70
|
| Rate for Payer: UHCCP Medicaid |
$1,133.70
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$7.49
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$2.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.87
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$7.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.30
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.18
|
| Rate for Payer: PACE SWMI |
$2.30
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health Medicare |
$2.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.30
|
| Rate for Payer: UHC Exchange |
$2.30
|
| Rate for Payer: UHC Medicare Advantage |
$2.30
|
| Rate for Payer: VA VA |
$2.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.87
|
| Rate for Payer: BCN Commercial |
$15.02
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
| Rate for Payer: Priority Health HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: PACE Senior Care Partners |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
| Rate for Payer: Priority Health HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.86
|
| Rate for Payer: UHC Exchange |
$4.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: VA VA |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$25.68
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.02
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.11
|
| Rate for Payer: BCN Commercial |
$19.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.42
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.42
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.10
|
| Rate for Payer: PACE SWMI |
$6.42
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.42
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCN Commercial |
$15.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.92
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.87
|
| Rate for Payer: BCN Commercial |
$25.44
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$29.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: PHP Commercial |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.97
|
| Rate for Payer: UHC Core |
$27.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.69
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.92
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.29
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$27.06
|
| Rate for Payer: BCN Commercial |
$25.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.23
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$29.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: PACE Senior Care Partners |
$7.82
|
| Rate for Payer: PACE SWMI |
$8.23
|
| Rate for Payer: PHP Commercial |
$27.98
|
| Rate for Payer: PHP Medicare Advantage |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.97
|
| Rate for Payer: UHC Core |
$27.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.23
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: VA VA |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.69
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$25.68
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$358.08
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: Aetna Commercial |
$304.37
|
| Rate for Payer: BCBS Trust/PPO |
$292.30
|
| Rate for Payer: BCN Commercial |
$276.72
|
| Rate for Payer: Cash Price |
$286.46
|
| Rate for Payer: Cofinity Commercial |
$307.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.46
|
| Rate for Payer: Healthscope Commercial |
$322.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.37
|
| Rate for Payer: Nomi Health Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$304.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: Priority Health HMO/PPO |
$311.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.11
|
| Rate for Payer: UHC Core |
$299.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.56
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.22 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.44
|
| Rate for Payer: BCBS Trust/PPO |
$613.12
|
| Rate for Payer: BCN Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.44
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: PHP Commercial |
$638.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.22
|
| Rate for Payer: Priority Health HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.32
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health HMO/PPO |
$3.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.16
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$794.76
|
|
|
Service Code
|
NDC 00093777201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: Aetna Commercial |
$675.55
|
| Rate for Payer: Aetna Medicare |
$206.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.36
|
| Rate for Payer: BCBS Complete |
$317.90
|
| Rate for Payer: BCBS MAPPO |
$198.69
|
| Rate for Payer: BCBS Trust/PPO |
$653.37
|
| Rate for Payer: BCN Commercial |
$617.93
|
| Rate for Payer: BCN Medicare Advantage |
$198.69
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cofinity Commercial |
$683.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.69
|
| Rate for Payer: Healthscope Commercial |
$715.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.55
|
| Rate for Payer: Nomi Health Commercial |
$651.70
|
| Rate for Payer: PACE Senior Care Partners |
$188.76
|
| Rate for Payer: PACE SWMI |
$198.69
|
| Rate for Payer: PHP Commercial |
$675.55
|
| Rate for Payer: PHP Medicare Advantage |
$198.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.59
|
| Rate for Payer: Priority Health HMO/PPO |
$691.44
|
| Rate for Payer: Priority Health Medicare |
$200.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.49
|
| Rate for Payer: Railroad Medicare Medicare |
$198.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.39
|
| Rate for Payer: UHC Core |
$663.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.69
|
| Rate for Payer: UHC Exchange |
$198.69
|
| Rate for Payer: UHC Medicare Advantage |
$198.69
|
| Rate for Payer: VA VA |
$198.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.07
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.90
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.90
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.90
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health HMO/PPO |
$3.12
|
| Rate for Payer: Priority Health Medicare |
$0.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| Rate for Payer: Railroad Medicare Medicare |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.16
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.90
|
| Rate for Payer: UHC Exchange |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$0.90
|
| Rate for Payer: VA VA |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$794.76
|
|
|
Service Code
|
NDC 00093777201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.59 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: Aetna Commercial |
$675.55
|
| Rate for Payer: BCBS Trust/PPO |
$648.76
|
| Rate for Payer: BCN Commercial |
$614.19
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cofinity Commercial |
$683.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.81
|
| Rate for Payer: Healthscope Commercial |
$715.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.55
|
| Rate for Payer: Nomi Health Commercial |
$651.70
|
| Rate for Payer: PHP Commercial |
$675.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.59
|
| Rate for Payer: Priority Health HMO/PPO |
$691.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.39
|
| Rate for Payer: UHC Core |
$663.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.07
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$358.08
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: Aetna Commercial |
$304.37
|
| Rate for Payer: Aetna Medicare |
$93.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: BCBS Complete |
$143.23
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCBS Trust/PPO |
$294.38
|
| Rate for Payer: BCN Commercial |
$278.41
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| Rate for Payer: Cash Price |
$286.46
|
| Rate for Payer: Cofinity Commercial |
$307.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$322.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.37
|
| Rate for Payer: Nomi Health Commercial |
$293.63
|
| Rate for Payer: PACE Senior Care Partners |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$304.37
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: Priority Health HMO/PPO |
$311.53
|
| Rate for Payer: Priority Health Medicare |
$90.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.11
|
| Rate for Payer: UHC Core |
$299.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$89.52
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: VA VA |
$89.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.56
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.39 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.44
|
| Rate for Payer: Aetna Medicare |
$195.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.72
|
| Rate for Payer: BCBS Complete |
$300.44
|
| Rate for Payer: BCBS MAPPO |
$187.78
|
| Rate for Payer: BCBS Trust/PPO |
$617.48
|
| Rate for Payer: BCN Commercial |
$583.98
|
| Rate for Payer: BCN Medicare Advantage |
$187.78
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.78
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.44
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: PACE Senior Care Partners |
$178.39
|
| Rate for Payer: PACE SWMI |
$187.78
|
| Rate for Payer: PHP Commercial |
$638.44
|
| Rate for Payer: PHP Medicare Advantage |
$187.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.22
|
| Rate for Payer: Priority Health HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Medicare |
$189.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.24
|
| Rate for Payer: Railroad Medicare Medicare |
$187.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.78
|
| Rate for Payer: UHC Exchange |
$187.78
|
| Rate for Payer: UHC Medicare Advantage |
$187.78
|
| Rate for Payer: VA VA |
$187.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.32
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687040411
|
| Hospital Charge Code |
9648
|
|
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
|
|
