|
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 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
|
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 |
$142.98
|
| 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
|
$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 |
$169.20
|
| Rate for Payer: Aetna Commercial |
$221.26
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| 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 |
$221.26
|
| Rate for Payer: PHP Commercial |
$221.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| 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
|
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 |
$169.20
|
| Rate for Payer: Aetna Commercial |
$221.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| 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 |
$221.26
|
| Rate for Payer: PHP Commercial |
$221.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| 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
|
$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 |
$2.14
|
| 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 |
$2.14
|
|
|
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 |
$45.82
|
| 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
|
$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 |
$2.14
|
| 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 |
$2.14
|
|
|
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
|
$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
|
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 |
$95.18
|
| 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 |
$95.18
|
|
|
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 |
$241.96 |
| 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 |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| 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
|
$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 |
$95.18
|
| 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 |
$95.18
|
|
|
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 |
$95.18
|
| 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 |
$95.18
|
|
|
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 |
$95.18
|
| 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 |
$95.18
|
|
|
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 |
$74.02
|
| 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
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.42
|
| 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 |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| 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
|
$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 |
$74.02
|
| 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
|
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 |
$132.52
|
| 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 |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| 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 |
$185.54
|
| 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
|
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 |
$218.02
|
| 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 |
$218.02
|
| Rate for Payer: PHP Commercial |
$218.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.60
|
| Rate for Payer: UMR Bronson Commercial |
$112.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
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 |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| 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 |
$185.54
|
| 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
|
$256.50
|
|
|
Service Code
|
NDC 43547043506
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.02
|
| 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 |
$218.02
|
| Rate for Payer: PHP Commercial |
$218.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.72
|
| Rate for Payer: Priority Health SBD |
$161.60
|
| Rate for Payer: UMR Bronson Commercial |
$94.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
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
|
$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
|
|
