|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 60687012411
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| 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: MI Amish Medical Board Commercial |
$2.18
|
| 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: UHC All Payor (Choice/PPO) |
$1.77
|
| Rate for Payer: UHC Core |
$1.42
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
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
|
$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
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 52817018110
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| 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: 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: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 52817018110
|
| 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
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| 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: 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: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$229.71
|
|
|
Service Code
|
NDC 43547043506
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$206.74 |
| Rate for Payer: Aetna American Axle |
$149.31
|
| Rate for Payer: Aetna Commercial |
$195.25
|
| Rate for Payer: Aetna Medicare |
$114.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.31
|
| Rate for Payer: BCBS Complete |
$91.88
|
| Rate for Payer: Cash Price |
$183.77
|
| Rate for Payer: Cofinity Advantage |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$197.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.77
|
| Rate for Payer: Healthscope Commercial |
$206.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.28
|
| Rate for Payer: PHP Commercial |
$195.25
|
| Rate for Payer: Priority Health SBD |
$144.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.31
|
| Rate for Payer: UHC Core |
$119.68
|
| Rate for Payer: UHC Exchange |
$90.28
|
| Rate for Payer: UMR Bronson Commercial |
$84.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.28
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 68180060607
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 68180060607
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$229.71
|
|
|
Service Code
|
NDC 43547043506
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.07 |
| Max. Negotiated Rate |
$206.74 |
| Rate for Payer: Aetna American Axle |
$149.31
|
| Rate for Payer: Aetna Commercial |
$195.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.31
|
| Rate for Payer: Cash Price |
$183.77
|
| Rate for Payer: Cofinity Advantage |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$197.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.77
|
| Rate for Payer: Healthscope Commercial |
$206.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.28
|
| Rate for Payer: PHP Commercial |
$195.25
|
| Rate for Payer: Priority Health SBD |
$144.72
|
| Rate for Payer: UMR Bronson Commercial |
$101.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.28
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$383.10
|
|
|
Service Code
|
NDC 00904646710
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$344.79 |
| Rate for Payer: Aetna American Axle |
$249.01
|
| Rate for Payer: Aetna Commercial |
$325.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.01
|
| Rate for Payer: Cash Price |
$306.48
|
| Rate for Payer: Cofinity Advantage |
$268.17
|
| Rate for Payer: Cofinity Commercial |
$329.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.48
|
| Rate for Payer: Healthscope Commercial |
$344.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.32
|
| Rate for Payer: PHP Commercial |
$325.63
|
| Rate for Payer: Priority Health SBD |
$241.35
|
| Rate for Payer: UMR Bronson Commercial |
$168.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.32
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$934.29
|
|
|
Service Code
|
NDC 63739017830
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.09 |
| Max. Negotiated Rate |
$840.86 |
| Rate for Payer: Aetna American Axle |
$607.29
|
| Rate for Payer: Aetna Commercial |
$794.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.29
|
| Rate for Payer: Cash Price |
$747.43
|
| Rate for Payer: Cofinity Advantage |
$654.00
|
| Rate for Payer: Cofinity Commercial |
$803.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.43
|
| Rate for Payer: Healthscope Commercial |
$840.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$700.72
|
| Rate for Payer: PHP Commercial |
$794.15
|
| Rate for Payer: Priority Health SBD |
$588.60
|
| Rate for Payer: UMR Bronson Commercial |
$411.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.72
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$421.36
|
|
|
Service Code
|
NDC 50268018412
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: Cash Price |
$337.09
|
| Rate for Payer: Cofinity Advantage |
$294.95
|
| Rate for Payer: Cofinity Commercial |
$362.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.09
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.02
|
| Rate for Payer: PHP Commercial |
$358.16
|
| Rate for Payer: Priority Health SBD |
$265.46
|
| Rate for Payer: UMR Bronson Commercial |
$185.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.02
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$1,685.98
|
|
|
Service Code
|
NDC 55111067131
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$623.81 |
| Max. Negotiated Rate |
$1,517.38 |
| Rate for Payer: Aetna American Axle |
$1,095.89
|
| Rate for Payer: Aetna Commercial |
$1,433.08
|
| Rate for Payer: Aetna Medicare |
$842.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.89
|
| Rate for Payer: BCBS Complete |
$674.39
|
| Rate for Payer: Cash Price |
$1,348.78
|
| Rate for Payer: Cofinity Advantage |
$1,180.19
|
| Rate for Payer: Cofinity Commercial |
$1,449.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.78
|
| Rate for Payer: Healthscope Commercial |
$1,517.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,264.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,348.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.48
|
| Rate for Payer: PHP Commercial |
$1,433.08
|
| Rate for Payer: Priority Health SBD |
$1,062.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.89
|
| Rate for Payer: UHC Core |
$878.40
|
| Rate for Payer: UHC Exchange |
$662.59
|
| Rate for Payer: UMR Bronson Commercial |
$623.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,264.48
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$383.10
|
|
|
Service Code
|
NDC 00904646710
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$344.79 |
| Rate for Payer: Aetna American Axle |
$249.01
|
| Rate for Payer: Aetna Commercial |
$325.63
|
| Rate for Payer: Aetna Medicare |
$191.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.01
|
| Rate for Payer: BCBS Complete |
$153.24
|
| Rate for Payer: Cash Price |
$306.48
|
| Rate for Payer: Cofinity Advantage |
$268.17
|
| Rate for Payer: Cofinity Commercial |
$329.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.48
|
| Rate for Payer: Healthscope Commercial |
$344.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.32
|
| Rate for Payer: PHP Commercial |
$325.63
|
| Rate for Payer: Priority Health SBD |
$241.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.01
|
| Rate for Payer: UHC Core |
$199.60
|
| Rate for Payer: UHC Exchange |
$150.56
|
| Rate for Payer: UMR Bronson Commercial |
$141.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.32
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$21.07
|
|
|
Service Code
|
NDC 50268018411
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$18.96 |
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Advantage |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.80
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$1,151.63
|
|
|
Service Code
|
NDC 00904646707
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.10 |
| Max. Negotiated Rate |
$1,036.47 |
| Rate for Payer: Aetna American Axle |
$748.56
|
| Rate for Payer: Aetna Commercial |
$978.89
|
| Rate for Payer: Aetna Medicare |
$575.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.56
|
| Rate for Payer: BCBS Complete |
$460.65
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cofinity Advantage |
$806.14
|
| Rate for Payer: Cofinity Commercial |
$990.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.30
|
| Rate for Payer: Healthscope Commercial |
$1,036.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$921.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.72
|
| Rate for Payer: PHP Commercial |
$978.89
|
| Rate for Payer: Priority Health SBD |
$725.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.56
|
| Rate for Payer: UHC Core |
$600.00
|
| Rate for Payer: UHC Exchange |
$452.59
|
| Rate for Payer: UMR Bronson Commercial |
$426.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.72
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$421.36
|
|
|
Service Code
|
NDC 50268018412
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.16
|
| Rate for Payer: Aetna Medicare |
$210.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: BCBS Complete |
$168.54
|
| Rate for Payer: Cash Price |
$337.09
|
| Rate for Payer: Cofinity Advantage |
$294.95
|
| Rate for Payer: Cofinity Commercial |
$362.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.09
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.02
|
| Rate for Payer: PHP Commercial |
$358.16
|
| Rate for Payer: Priority Health SBD |
$265.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.88
|
| Rate for Payer: UHC Core |
$219.53
|
| Rate for Payer: UHC Exchange |
$165.59
|
| Rate for Payer: UMR Bronson Commercial |
$155.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.02
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$21.07
|
|
|
Service Code
|
NDC 50268018411
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$18.96 |
| Rate for Payer: Aetna American Axle |
$13.70
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: BCBS Complete |
$8.43
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Advantage |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.80
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.70
|
| Rate for Payer: UHC Core |
$10.98
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.80
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$1,151.63
|
|
|
Service Code
|
NDC 00904646707
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.72 |
| Max. Negotiated Rate |
$1,036.47 |
| Rate for Payer: Aetna American Axle |
$748.56
|
| Rate for Payer: Aetna Commercial |
$978.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.56
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cofinity Advantage |
$806.14
|
| Rate for Payer: Cofinity Commercial |
$990.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.30
|
| Rate for Payer: Healthscope Commercial |
$1,036.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.72
|
| Rate for Payer: PHP Commercial |
$978.89
|
| Rate for Payer: Priority Health SBD |
$725.53
|
| Rate for Payer: UMR Bronson Commercial |
$506.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.72
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$1,685.98
|
|
|
Service Code
|
NDC 55111067131
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.83 |
| Max. Negotiated Rate |
$1,517.38 |
| Rate for Payer: Aetna American Axle |
$1,095.89
|
| Rate for Payer: Aetna Commercial |
$1,433.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.89
|
| Rate for Payer: Cash Price |
$1,348.78
|
| Rate for Payer: Cofinity Advantage |
$1,180.19
|
| Rate for Payer: Cofinity Commercial |
$1,449.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.78
|
| Rate for Payer: Healthscope Commercial |
$1,517.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,264.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.48
|
| Rate for Payer: PHP Commercial |
$1,433.08
|
| Rate for Payer: Priority Health SBD |
$1,062.17
|
| Rate for Payer: UMR Bronson Commercial |
$741.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,264.48
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$934.29
|
|
|
Service Code
|
NDC 63739017830
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.69 |
| Max. Negotiated Rate |
$840.86 |
| Rate for Payer: Aetna American Axle |
$607.29
|
| Rate for Payer: Aetna Commercial |
$794.15
|
| Rate for Payer: Aetna Medicare |
$467.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.29
|
| Rate for Payer: BCBS Complete |
$373.72
|
| Rate for Payer: Cash Price |
$747.43
|
| Rate for Payer: Cofinity Advantage |
$654.00
|
| Rate for Payer: Cofinity Commercial |
$803.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.43
|
| Rate for Payer: Healthscope Commercial |
$840.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$747.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$700.72
|
| Rate for Payer: PHP Commercial |
$794.15
|
| Rate for Payer: Priority Health SBD |
$588.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.29
|
| Rate for Payer: UHC Core |
$486.77
|
| Rate for Payer: UHC Exchange |
$367.18
|
| Rate for Payer: UMR Bronson Commercial |
$345.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.72
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna American Axle |
$169.19
|
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Advantage |
$182.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$182.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.19
|
| Rate for Payer: UHC Core |
$135.62
|
| Rate for Payer: UHC Exchange |
$102.30
|
| Rate for Payer: UMR Bronson Commercial |
$96.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$97.29
|
|
|
Service Code
|
NDC 16729021815
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$87.56 |
| Rate for Payer: Aetna American Axle |
$63.24
|
| Rate for Payer: Aetna Commercial |
$82.70
|
| Rate for Payer: Aetna Medicare |
$48.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.24
|
| Rate for Payer: BCBS Complete |
$38.92
|
| Rate for Payer: Cash Price |
$77.83
|
| Rate for Payer: Cofinity Advantage |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$83.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.83
|
| Rate for Payer: Healthscope Commercial |
$87.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.97
|
| Rate for Payer: PHP Commercial |
$82.70
|
| Rate for Payer: Priority Health SBD |
$61.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.24
|
| Rate for Payer: UHC Core |
$50.69
|
| Rate for Payer: UHC Exchange |
$38.23
|
| Rate for Payer: UMR Bronson Commercial |
$36.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.97
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
