|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.49 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: BCBS Trust/PPO |
$216.55
|
| Rate for Payer: BCN Commercial |
$216.55
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.74
|
| Rate for Payer: UHC Core |
$218.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 50268019211
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.22
|
| Rate for Payer: Mclaren Medicaid |
$0.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.22
|
| Rate for Payer: PACE Senior Care Partners |
$0.70
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicaid |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.52
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.22
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: BCBS Trust/PPO |
$69.87
|
| Rate for Payer: BCN Commercial |
$69.87
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.44
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: BCN Medicare Advantage |
$21.15
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.21
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.09
|
| Rate for Payer: PACE SWMI |
$21.15
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$21.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: UHC Exchange |
$21.15
|
| Rate for Payer: UHC Medicaid |
$14.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.15
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: VA VA |
$21.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$147.73
|
|
|
Service Code
|
NDC 50268019215
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$132.96 |
| Rate for Payer: Aetna Commercial |
$125.57
|
| Rate for Payer: BCBS Trust/PPO |
$122.01
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: Cash Price |
$118.18
|
| Rate for Payer: Cofinity Commercial |
$127.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.18
|
| Rate for Payer: Healthscope Commercial |
$132.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.57
|
| Rate for Payer: Nomi Health Commercial |
$121.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.80
|
| Rate for Payer: PHP Commercial |
$125.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.00
|
| Rate for Payer: UHC Core |
$123.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.80
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.94
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$215.55
|
| Rate for Payer: BCN Commercial |
$215.55
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Mclaren Medicaid |
$46.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.83
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PACE Senior Care Partners |
$62.27
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.11
|
| Rate for Payer: Priority Health Medicare |
$66.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.49
|
| Rate for Payer: Railroad Medicare Medicare |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.74
|
| Rate for Payer: UHC Core |
$218.94
|
| Rate for Payer: UHC Exchange |
$65.55
|
| Rate for Payer: UHC Medicaid |
$46.23
|
| Rate for Payer: UHC Medicare Advantage |
$65.55
|
| Rate for Payer: UHCCP Medicaid |
$46.23
|
| Rate for Payer: VA VA |
$65.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.53
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Medicare |
$74.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.95
|
| Rate for Payer: BCBS Complete |
$53.28
|
| Rate for Payer: BCBS MAPPO |
$71.96
|
| Rate for Payer: BCBS Trust/PPO |
$236.64
|
| Rate for Payer: BCN Commercial |
$236.64
|
| Rate for Payer: BCN Medicare Advantage |
$71.96
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.96
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Mclaren Medicaid |
$50.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.56
|
| Rate for Payer: Meridian Medicaid |
$53.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PACE Senior Care Partners |
$68.36
|
| Rate for Payer: PACE SWMI |
$71.96
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: PHP Medicare Advantage |
$71.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.43
|
| Rate for Payer: Priority Health Medicare |
$72.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.34
|
| Rate for Payer: Railroad Medicare Medicare |
$71.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.31
|
| Rate for Payer: UHC Core |
$240.35
|
| Rate for Payer: UHC Exchange |
$71.96
|
| Rate for Payer: UHC Medicaid |
$50.75
|
| Rate for Payer: UHC Medicare Advantage |
$71.96
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: VA VA |
$71.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.34 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: BCBS Trust/PPO |
$237.74
|
| Rate for Payer: BCN Commercial |
$237.74
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.31
|
| Rate for Payer: UHC Core |
$240.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.82
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Mclaren Medicaid |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.30
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.46
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.26 |
| 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 |
$74.82
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCN Commercial |
$332.29
|
| 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: Mclaren Medicaid |
$71.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| 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 Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| 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 Exchange |
$101.05
|
| Rate for Payer: UHC Medicaid |
$71.26
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: UHCCP Medicaid |
$71.26
|
| 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 |
$281.32 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: BCBS Trust/PPO |
$333.83
|
| Rate for Payer: BCN Commercial |
$333.83
|
| 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: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| 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
|
$260.30
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$67.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.34
|
| Rate for Payer: BCBS Complete |
$48.18
|
| Rate for Payer: BCBS MAPPO |
$65.08
|
| Rate for Payer: BCBS Trust/PPO |
$213.99
|
| Rate for Payer: BCN Commercial |
$213.99
|
| Rate for Payer: BCN Medicare Advantage |
$65.08
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.08
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.22
|
| Rate for Payer: Mclaren Medicaid |
$45.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Medicaid |
$48.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Nomi Health Commercial |
$213.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PACE Senior Care Partners |
$61.82
|
| Rate for Payer: PACE SWMI |
$65.08
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: PHP Medicare Advantage |
$65.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.46
|
| Rate for Payer: Priority Health Medicare |
$65.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.17
|
| Rate for Payer: Railroad Medicare Medicare |
$65.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.06
|
| Rate for Payer: UHC Core |
$217.35
|
| Rate for Payer: UHC Exchange |
$65.08
|
| Rate for Payer: UHC Medicaid |
$45.89
|
| Rate for Payer: UHC Medicare Advantage |
$65.08
|
| Rate for Payer: UHCCP Medicaid |
$45.89
|
| Rate for Payer: VA VA |
$65.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.30
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.17 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: BCBS Trust/PPO |
$214.98
|
| Rate for Payer: BCN Commercial |
$214.98
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Nomi Health Commercial |
$213.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.06
|
| Rate for Payer: UHC Core |
$217.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.21
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.26
|
| Rate for Payer: BCN Commercial |
$9.26
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: Nomi Health Commercial |
$9.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| 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 |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.98
|
| 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: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.58
|
| 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 Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.53
|
| 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 Exchange |
$4.86
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.21
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Aetna Medicare |
$2.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: BCBS MAPPO |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$9.22
|
| Rate for Payer: BCN Medicare Advantage |
$2.80
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Mclaren Medicaid |
$1.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.94
|
| Rate for Payer: Meridian Medicaid |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: Nomi Health Commercial |
$9.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PACE Senior Care Partners |
$2.66
|
| Rate for Payer: PACE SWMI |
$2.80
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: PHP Medicare Advantage |
$2.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: UHC Exchange |
$2.80
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.80
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: VA VA |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| 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: Opus (Opus Packaging Group) HMA |
$14.58
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.53
|
| 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-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 |
$13.58 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$16.11
|
| Rate for Payer: BCN Commercial |
$16.11
|
| 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: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.58
|
| 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
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$26.15
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$22.23
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.17
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$21.50
|
| Rate for Payer: BCN Commercial |
$21.50
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.61
|
| Rate for Payer: Mclaren Medicaid |
$4.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.86
|
| Rate for Payer: Meridian Medicaid |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.23
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.61
|
| Rate for Payer: PACE Senior Care Partners |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PHP Commercial |
$22.23
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$6.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.20
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.01
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHC Medicaid |
$4.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.54
|
| Rate for Payer: UHCCP Medicaid |
$4.61
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.61
|
|
|
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 |
$22.91 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCN Commercial |
$27.19
|
| 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: Opus (Opus Packaging Group) HMA |
$24.69
|
| Rate for Payer: PHP Commercial |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.91
|
| 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 |
$5.80 |
| 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 |
$6.09
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$27.06
|
| Rate for Payer: BCN Commercial |
$27.06
|
| 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: Mclaren Medicaid |
$5.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Medicaid |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.69
|
| 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 Choice Medicaid |
$5.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.91
|
| 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 Exchange |
$8.23
|
| Rate for Payer: UHC Medicaid |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: UHCCP Medicaid |
$5.80
|
| 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
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.44 |
| 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 |
$3.61
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCN Commercial |
$16.04
|
| 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: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| 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 Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.58
|
| 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 Exchange |
$4.88
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| 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
|
$26.15
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.60
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$23.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.23
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.61
|
| Rate for Payer: PHP Commercial |
$22.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.01
|
| Rate for Payer: UHC Core |
$21.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.61
|
|
