|
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
|
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
|
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 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
|
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 |
$10.72
|
| 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
|
$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
|
$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
|
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 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 |
$48.64
|
| 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
|
$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
|
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
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 00904629401
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$187.24 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$145.64
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.64
|
| 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 |
$91.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| 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 |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
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 |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| 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 |
$290.22
|
| 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
|
$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
|
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
|
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 |
$2.24
|
| 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
|
|
|
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 |
$187.24 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$104.02
|
| 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 |
$145.64
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.64
|
| 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
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 51672404201
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
OP
|
$376.32
|
|
|
Service Code
|
NDC 13107031901
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$338.69 |
| Rate for Payer: Aetna American Axle |
$244.61
|
| Rate for Payer: Aetna Commercial |
$319.87
|
| Rate for Payer: Aetna Medicare |
$188.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.61
|
| Rate for Payer: BCBS Complete |
$150.53
|
| Rate for Payer: Cash Price |
$301.06
|
| Rate for Payer: Cofinity Commercial |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$323.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.06
|
| Rate for Payer: Healthscope Commercial |
$338.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.87
|
| Rate for Payer: PHP Commercial |
$319.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.61
|
| Rate for Payer: Priority Health SBD |
$237.08
|
| Rate for Payer: UMR Bronson Commercial |
$139.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.24
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
NDC 51672404201
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.28 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna Medicare |
$222.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$164.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
IP
|
$413.76
|
|
|
Service Code
|
NDC 60505475401
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.05 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Commercial |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.94
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UMR Bronson Commercial |
$182.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
IP
|
$376.32
|
|
|
Service Code
|
NDC 13107031901
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.58 |
| Max. Negotiated Rate |
$338.69 |
| Rate for Payer: Aetna American Axle |
$244.61
|
| Rate for Payer: Aetna Commercial |
$319.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.61
|
| Rate for Payer: Cash Price |
$301.06
|
| Rate for Payer: Cofinity Commercial |
$263.42
|
| Rate for Payer: Cofinity Commercial |
$323.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.06
|
| Rate for Payer: Healthscope Commercial |
$338.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.87
|
| Rate for Payer: PHP Commercial |
$319.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.61
|
| Rate for Payer: Priority Health SBD |
$237.08
|
| Rate for Payer: UMR Bronson Commercial |
$165.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.24
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
OP
|
$413.76
|
|
|
Service Code
|
NDC 60505475401
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.09 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna Medicare |
$206.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Commercial |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.94
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UMR Bronson Commercial |
$153.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT; WITH MANIPULATION, EACH
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26742
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$329.74 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$988.70
|
| Rate for Payer: BCN Commercial |
$988.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.71
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$329.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
