|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 00228212810
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: BCBS Complete |
$47.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 00228212810
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| 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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| 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
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 43547043506
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UMR Bronson Commercial |
$94.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$256.50
|
|
|
Service Code
|
NDC 43547043506
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$873.13
|
|
|
Service Code
|
NDC 00904646707
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.06 |
| Max. Negotiated Rate |
$785.82 |
| Rate for Payer: Aetna American Axle |
$567.53
|
| Rate for Payer: Aetna Commercial |
$742.16
|
| Rate for Payer: Aetna Medicare |
$436.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.53
|
| Rate for Payer: BCBS Complete |
$349.25
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cofinity Commercial |
$611.19
|
| Rate for Payer: Cofinity Commercial |
$750.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$611.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$698.50
|
| Rate for Payer: Healthscope Commercial |
$785.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$611.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$654.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.16
|
| Rate for Payer: PHP Commercial |
$742.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.53
|
| Rate for Payer: Priority Health SBD |
$550.07
|
| Rate for Payer: UMR Bronson Commercial |
$323.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$654.85
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 50268018411
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Aetna American Axle |
$13.93
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.93
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$18.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health SBD |
$13.50
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.07
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$428.54
|
|
|
Service Code
|
NDC 50268018412
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.56 |
| Max. Negotiated Rate |
$385.69 |
| Rate for Payer: Aetna American Axle |
$278.55
|
| Rate for Payer: Aetna Commercial |
$364.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.55
|
| Rate for Payer: Cash Price |
$342.83
|
| Rate for Payer: Cofinity Commercial |
$299.98
|
| Rate for Payer: Cofinity Commercial |
$368.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.83
|
| Rate for Payer: Healthscope Commercial |
$385.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.26
|
| Rate for Payer: PHP Commercial |
$364.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.55
|
| Rate for Payer: Priority Health SBD |
$269.98
|
| Rate for Payer: UMR Bronson Commercial |
$188.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.40
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$428.54
|
|
|
Service Code
|
NDC 50268018412
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$385.69 |
| Rate for Payer: Aetna American Axle |
$278.55
|
| Rate for Payer: Aetna Commercial |
$364.26
|
| Rate for Payer: Aetna Medicare |
$214.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.55
|
| Rate for Payer: BCBS Complete |
$171.42
|
| Rate for Payer: Cash Price |
$342.83
|
| Rate for Payer: Cofinity Commercial |
$299.98
|
| Rate for Payer: Cofinity Commercial |
$368.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.83
|
| Rate for Payer: Healthscope Commercial |
$385.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.26
|
| Rate for Payer: PHP Commercial |
$364.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.55
|
| Rate for Payer: Priority Health SBD |
$269.98
|
| Rate for Payer: UMR Bronson Commercial |
$158.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.40
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
NDC 50268018411
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Aetna American Axle |
$13.93
|
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.93
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$15.00
|
| Rate for Payer: Cofinity Commercial |
$18.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.22
|
| Rate for Payer: PHP Commercial |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health SBD |
$13.50
|
| Rate for Payer: UMR Bronson Commercial |
$9.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.07
|
|
|
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 Commercial |
$654.00
|
| Rate for Payer: Cofinity Commercial |
$803.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$654.00
|
| 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: PHP Commercial |
$794.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.29
|
| 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
|
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 Commercial |
$654.00
|
| Rate for Payer: Cofinity Commercial |
$803.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$654.00
|
| 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: PHP Commercial |
$794.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.29
|
| Rate for Payer: Priority Health SBD |
$588.60
|
| Rate for Payer: UMR Bronson Commercial |
$345.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.72
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
OP
|
$1,798.43
|
|
|
Service Code
|
NDC 55111067131
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$665.42 |
| Max. Negotiated Rate |
$1,618.59 |
| Rate for Payer: Aetna American Axle |
$1,168.98
|
| Rate for Payer: Aetna Commercial |
$1,528.67
|
| Rate for Payer: Aetna Medicare |
$899.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.98
|
| Rate for Payer: BCBS Complete |
$719.37
|
| Rate for Payer: Cash Price |
$1,438.74
|
| Rate for Payer: Cofinity Commercial |
$1,258.90
|
| Rate for Payer: Cofinity Commercial |
$1,546.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,258.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,438.74
|
| Rate for Payer: Healthscope Commercial |
$1,618.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,258.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,348.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,528.67
|
| Rate for Payer: PHP Commercial |
$1,528.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,168.98
|
| Rate for Payer: Priority Health SBD |
$1,133.01
|
| Rate for Payer: UMR Bronson Commercial |
$665.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,348.82
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$1,798.43
|
|
|
Service Code
|
NDC 55111067131
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$791.31 |
| Max. Negotiated Rate |
$1,618.59 |
| Rate for Payer: Aetna American Axle |
$1,168.98
|
| Rate for Payer: Aetna Commercial |
$1,528.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.98
|
| Rate for Payer: Cash Price |
$1,438.74
|
| Rate for Payer: Cofinity Commercial |
$1,258.90
|
| Rate for Payer: Cofinity Commercial |
$1,546.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,258.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,438.74
|
| Rate for Payer: Healthscope Commercial |
$1,618.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,258.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,348.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,528.67
|
| Rate for Payer: PHP Commercial |
$1,528.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,168.98
|
| Rate for Payer: Priority Health SBD |
$1,133.01
|
| Rate for Payer: UMR Bronson Commercial |
$791.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,348.82
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$873.13
|
|
|
Service Code
|
NDC 00904646707
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$384.18 |
| Max. Negotiated Rate |
$785.82 |
| Rate for Payer: Aetna American Axle |
$567.53
|
| Rate for Payer: Aetna Commercial |
$742.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.53
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cofinity Commercial |
$611.19
|
| Rate for Payer: Cofinity Commercial |
$750.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$611.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$698.50
|
| Rate for Payer: Healthscope Commercial |
$785.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$611.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$654.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.16
|
| Rate for Payer: PHP Commercial |
$742.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.53
|
| Rate for Payer: Priority Health SBD |
$550.07
|
| Rate for Payer: UMR Bronson Commercial |
$384.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$654.85
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 00904629401
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.98 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: UMR Bronson Commercial |
$76.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$97.29
|
|
|
Service Code
|
NDC 16729021815
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$87.56 |
| Rate for Payer: Aetna American Axle |
$63.24
|
| Rate for Payer: Aetna Commercial |
$82.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.24
|
| Rate for Payer: Cash Price |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$83.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.10
|
| 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: Multiplan/Beech St/PHCS Commercial |
$82.70
|
| Rate for Payer: PHP Commercial |
$82.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.24
|
| Rate for Payer: Priority Health SBD |
$61.29
|
| Rate for Payer: UMR Bronson Commercial |
$42.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.97
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
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 Commercial |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$83.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.10
|
| 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: Multiplan/Beech St/PHCS Commercial |
$82.70
|
| Rate for Payer: PHP Commercial |
$82.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.24
|
| Rate for Payer: Priority Health SBD |
$61.29
|
| 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
|
$4.47
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna American Axle |
$2.91
|
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.80
|
| Rate for Payer: PHP Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna American Axle |
$2.91
|
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.80
|
| Rate for Payer: PHP Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
