|
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 |
$160.48 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UMR Bronson Commercial |
$160.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 75907002311
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna American Axle |
$19.94
|
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Advantage |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.54
|
| Rate for Payer: Healthscope Commercial |
$27.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.07
|
| Rate for Payer: Priority Health SBD |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.94
|
| Rate for Payer: UHC Core |
$15.98
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.00
|
|
|
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 |
$134.95 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna Medicare |
$182.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.07
|
| Rate for Payer: UHC Core |
$190.02
|
| Rate for Payer: UHC Exchange |
$143.33
|
| Rate for Payer: UMR Bronson Commercial |
$134.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$364.72
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna American Axle |
$237.07
|
| Rate for Payer: Aetna Commercial |
$310.01
|
| Rate for Payer: Aetna Medicare |
$182.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.07
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: Cash Price |
$291.78
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: PHP Commercial |
$310.01
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.07
|
| Rate for Payer: UHC Core |
$190.02
|
| Rate for Payer: UHC Exchange |
$143.33
|
| Rate for Payer: UMR Bronson Commercial |
$134.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.54
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$122.67
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna American Axle |
$79.74
|
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna Medicare |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.74
|
| Rate for Payer: BCBS Complete |
$49.07
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cofinity Advantage |
$85.87
|
| Rate for Payer: Cofinity Commercial |
$105.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.14
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.74
|
| Rate for Payer: UHC Core |
$63.91
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UMR Bronson Commercial |
$45.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
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 |
$227.20 |
| Max. Negotiated Rate |
$552.65 |
| Rate for Payer: Aetna American Axle |
$399.14
|
| Rate for Payer: Aetna Commercial |
$521.95
|
| Rate for Payer: Aetna Medicare |
$307.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.14
|
| Rate for Payer: BCBS Complete |
$245.62
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cofinity Advantage |
$429.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$429.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$491.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.55
|
| Rate for Payer: PHP Commercial |
$521.95
|
| Rate for Payer: Priority Health SBD |
$386.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.14
|
| Rate for Payer: UHC Core |
$319.93
|
| Rate for Payer: UHC Exchange |
$241.33
|
| Rate for Payer: UMR Bronson Commercial |
$227.20
|
| 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 |
$56.80 |
| Max. Negotiated Rate |
$138.17 |
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: Aetna Medicare |
$76.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Advantage |
$107.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$107.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.14
|
| Rate for Payer: PHP Commercial |
$130.49
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.79
|
| Rate for Payer: UHC Core |
$79.98
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UMR Bronson Commercial |
$56.80
|
| 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 |
$67.55 |
| Max. Negotiated Rate |
$138.17 |
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna Commercial |
$130.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Advantage |
$107.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$107.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.14
|
| Rate for Payer: PHP Commercial |
$130.49
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: UMR Bronson Commercial |
$67.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.14
|
|
|
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 |
$270.19 |
| Max. Negotiated Rate |
$552.65 |
| Rate for Payer: Aetna American Axle |
$399.14
|
| Rate for Payer: Aetna Commercial |
$521.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.14
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cofinity Advantage |
$429.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$429.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.55
|
| Rate for Payer: PHP Commercial |
$521.95
|
| Rate for Payer: Priority Health SBD |
$386.86
|
| Rate for Payer: UMR Bronson Commercial |
$270.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.55
|
|
|
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 |
$93.71 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna American Axle |
$138.43
|
| Rate for Payer: Aetna Commercial |
$181.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.43
|
| Rate for Payer: Cash Price |
$170.38
|
| Rate for Payer: Cofinity Advantage |
$149.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$149.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.73
|
| Rate for Payer: PHP Commercial |
$181.02
|
| Rate for Payer: Priority Health SBD |
$134.17
|
| Rate for Payer: UMR Bronson Commercial |
$93.71
|
| 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 |
$374.82 |
| Max. Negotiated Rate |
$766.67 |
| Rate for Payer: Aetna American Axle |
$553.71
|
| Rate for Payer: Aetna Commercial |
$724.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.71
|
| Rate for Payer: Cash Price |
$681.49
|
| Rate for Payer: Cofinity Advantage |
$596.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$596.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.89
|
| Rate for Payer: PHP Commercial |
$724.08
|
| Rate for Payer: Priority Health SBD |
$536.67
|
| Rate for Payer: UMR Bronson Commercial |
$374.82
|
| 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 |
$315.19 |
| Max. Negotiated Rate |
$766.67 |
| Rate for Payer: Aetna American Axle |
$553.71
|
| Rate for Payer: Aetna Commercial |
$724.08
|
| Rate for Payer: Aetna Medicare |
$425.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.71
|
| Rate for Payer: BCBS Complete |
$340.74
|
| Rate for Payer: Cash Price |
$681.49
|
| Rate for Payer: Cofinity Advantage |
$596.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$596.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.89
|
| Rate for Payer: PHP Commercial |
$724.08
|
| Rate for Payer: Priority Health SBD |
$536.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.71
|
| Rate for Payer: UHC Core |
$443.82
|
| Rate for Payer: UHC Exchange |
$334.78
|
| Rate for Payer: UMR Bronson Commercial |
$315.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.89
|
|
|
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 |
$78.80 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna American Axle |
$138.43
|
| Rate for Payer: Aetna Commercial |
$181.02
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.43
|
| Rate for Payer: BCBS Complete |
$85.19
|
| Rate for Payer: Cash Price |
$170.38
|
| Rate for Payer: Cofinity Advantage |
$149.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$149.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.73
|
| Rate for Payer: PHP Commercial |
$181.02
|
| Rate for Payer: Priority Health SBD |
$134.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.43
|
| Rate for Payer: UHC Core |
$110.96
|
| Rate for Payer: UHC Exchange |
$83.70
|
| Rate for Payer: UMR Bronson Commercial |
$78.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.73
|
|
|
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 |
$115.37 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UMR Bronson Commercial |
$115.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
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 |
$37.22 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Advantage |
$59.22
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
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 |
$1.27 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna American Axle |
$1.87
|
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.16
|
|
|
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 |
$97.01 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
| Rate for Payer: UMR Bronson Commercial |
$97.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
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 |
$31.30 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$42.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Advantage |
$59.22
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.99
|
| Rate for Payer: UHC Core |
$44.08
|
| Rate for Payer: UHC Exchange |
$33.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
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 |
$106.50 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna American Axle |
$187.10
|
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Medicare |
$143.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: BCBS Complete |
$115.14
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Advantage |
$201.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$201.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health SBD |
$181.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.10
|
| Rate for Payer: UHC Core |
$149.97
|
| Rate for Payer: UHC Exchange |
$113.13
|
| Rate for Payer: UMR Bronson Commercial |
$106.50
|
| 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 |
$126.65 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna American Axle |
$187.10
|
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Advantage |
$201.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$201.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: Priority Health SBD |
$181.35
|
| Rate for Payer: UMR Bronson Commercial |
$126.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.89
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 00228212810
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Advantage |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.22
|
| Rate for Payer: UHC Core |
$142.05
|
| Rate for Payer: UHC Exchange |
$107.15
|
| Rate for Payer: UMR Bronson Commercial |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 60687012411
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Advantage |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 29300013601
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
