|
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 0.1 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
|
$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 |
$68.39
|
| 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 |
$68.39
|
|
|
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 |
$113.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.97
|
| 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
|
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 0.2 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 |
$460.55
|
| 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 |
$460.55
|
|
|
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 |
$153.51
|
| Rate for Payer: BCBS Trust/PPO |
$504.82
|
| Rate for Payer: BCN Commercial |
$477.43
|
| Rate for Payer: BCN Medicare Advantage |
$153.51
|
| 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 |
$153.51
|
| Rate for Payer: Healthscope Commercial |
$552.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.55
|
| 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 |
$153.51
|
| Rate for Payer: PHP Commercial |
$521.95
|
| Rate for Payer: PHP Medicare Advantage |
$153.51
|
| 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 |
$153.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.37
|
| Rate for Payer: UHC Core |
$512.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.51
|
| Rate for Payer: UHC Exchange |
$153.51
|
| Rate for Payer: UHC Medicare Advantage |
$153.51
|
| Rate for Payer: VA VA |
$153.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.55
|
|
|
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
|
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 0.3 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
|
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 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 |
$638.89
|
| 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 |
$638.89
|
|
|
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 |
$212.97
|
| Rate for Payer: BCBS Trust/PPO |
$700.31
|
| Rate for Payer: BCN Commercial |
$662.32
|
| Rate for Payer: BCN Medicare Advantage |
$212.97
|
| 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 |
$212.97
|
| Rate for Payer: Healthscope Commercial |
$766.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.89
|
| 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 |
$212.97
|
| Rate for Payer: PHP Commercial |
$724.08
|
| Rate for Payer: PHP Medicare Advantage |
$212.97
|
| 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 |
$212.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.64
|
| Rate for Payer: UHC Core |
$711.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.97
|
| Rate for Payer: UHC Exchange |
$212.97
|
| Rate for Payer: UHC Medicare Advantage |
$212.97
|
| Rate for Payer: VA VA |
$212.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.89
|
|
|
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
|
|
|
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
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.72
|
| 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: Health Alliance Plan Medicare Advantage |
$0.72
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.72
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| Rate for Payer: Railroad Medicare Medicare |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.72
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
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 |
$2.15
|
| 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 |
$2.15
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
$1,215.03
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
|
|
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
|
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
|
|
