|
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 Commercial |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.46
|
| 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: PHP Commercial |
$130.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| 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
|
$1,681.65
|
|
|
Service Code
|
NDC 00597003234
|
| Hospital Charge Code |
27506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$739.93 |
| Max. Negotiated Rate |
$1,513.48 |
| Rate for Payer: Aetna American Axle |
$1,093.07
|
| Rate for Payer: Aetna Commercial |
$1,429.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.07
|
| Rate for Payer: Cash Price |
$1,345.32
|
| Rate for Payer: Cofinity Commercial |
$1,177.15
|
| Rate for Payer: Cofinity Commercial |
$1,446.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,177.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,345.32
|
| Rate for Payer: Healthscope Commercial |
$1,513.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,177.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,261.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,429.40
|
| Rate for Payer: PHP Commercial |
$1,429.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.07
|
| Rate for Payer: Priority Health SBD |
$1,059.44
|
| Rate for Payer: UMR Bronson Commercial |
$739.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,261.24
|
|
|
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 Commercial |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.46
|
| 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: PHP Commercial |
$130.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| 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
|
$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 Commercial |
$429.84
|
| Rate for Payer: Cofinity Commercial |
$528.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.84
|
| 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: PHP Commercial |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.14
|
| 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 0.2 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 Commercial |
$429.84
|
| Rate for Payer: Cofinity Commercial |
$528.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.84
|
| 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: PHP Commercial |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.14
|
| Rate for Payer: Priority Health SBD |
$386.86
|
| Rate for Payer: UMR Bronson Commercial |
$227.20
|
| 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 Commercial |
$149.08
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.08
|
| 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: PHP Commercial |
$181.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.43
|
| 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
|
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 Commercial |
$596.30
|
| Rate for Payer: Cofinity Commercial |
$732.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$596.30
|
| 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: PHP Commercial |
$724.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.71
|
| Rate for Payer: Priority Health SBD |
$536.67
|
| 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 Commercial |
$149.08
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.08
|
| 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: PHP Commercial |
$181.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.43
|
| Rate for Payer: Priority Health SBD |
$134.17
|
| Rate for Payer: UMR Bronson Commercial |
$78.80
|
| 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 Commercial |
$596.30
|
| Rate for Payer: Cofinity Commercial |
$732.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$596.30
|
| 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: PHP Commercial |
$724.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.71
|
| 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 HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna American Axle |
$1.86
|
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.86
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna American Axle |
$169.19
|
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.21
|
| 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: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.19
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UMR Bronson Commercial |
$114.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna American Axle |
$185.87
|
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$142.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.87
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health SBD |
$180.15
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna American Axle |
$1.86
|
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.86
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
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 Commercial |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.21
|
| 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: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.19
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UMR Bronson Commercial |
$96.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.22
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna American Axle |
$185.87
|
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.87
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health SBD |
$180.15
|
| Rate for Payer: UMR Bronson Commercial |
$125.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
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 Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| 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: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| 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
|
$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 Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| 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: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| 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 Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| 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: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| 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
|
$268.85
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 60687012411
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$99.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 60687012411
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 29300013601
|
| 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 Commercial |
$109.13
|
| Rate for Payer: Cofinity Commercial |
$88.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.83
|
| 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: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.48
|
| 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
|
|
