|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$254.64
|
|
|
Service Code
|
NDC 0378-0873-99
|
| Hospital Charge Code |
27507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$229.18 |
| Rate for Payer: Aetna American Axle |
$165.52
|
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.52
|
| Rate for Payer: Cash Price |
$203.71
|
| Rate for Payer: Cofinity Commercial |
$178.25
|
| Rate for Payer: Cofinity Commercial |
$218.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.71
|
| Rate for Payer: Healthscope Commercial |
$229.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.25
|
| Rate for Payer: Priority Health SBD |
$160.42
|
| Rate for Payer: UMR Bronson Commercial |
$112.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.98
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
NDC 60687-113-01
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 60687-113-01
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 0228-2127-10
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$266.95
|
|
|
Service Code
|
NDC 60687-124-01
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$240.26 |
| Rate for Payer: Aetna American Axle |
$173.52
|
| Rate for Payer: Aetna Commercial |
$226.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$186.86
|
| Rate for Payer: Cofinity Commercial |
$229.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$240.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.91
|
| Rate for Payer: PHP Commercial |
$226.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.86
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: UMR Bronson Commercial |
$117.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.21
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 60687-124-11
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
CLONIDINE HCL 0.2 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 29300-136-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.83
|
| 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
|
$126.90
|
|
|
Service Code
|
NDC 52817-181-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.83
|
| 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
|
$115.15
|
|
|
Service Code
|
NDC 0228-2128-10
|
| Hospital Charge Code |
1756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$250.23
|
|
|
Service Code
|
NDC 43547-435-06
|
| Hospital Charge Code |
107665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$225.21 |
| Rate for Payer: Aetna American Axle |
$162.65
|
| Rate for Payer: Aetna Commercial |
$212.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.65
|
| Rate for Payer: Cash Price |
$200.18
|
| Rate for Payer: Cofinity Commercial |
$175.16
|
| Rate for Payer: Cofinity Commercial |
$215.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.18
|
| Rate for Payer: Healthscope Commercial |
$225.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.70
|
| Rate for Payer: PHP Commercial |
$212.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.16
|
| Rate for Payer: Priority Health SBD |
$157.64
|
| Rate for Payer: UMR Bronson Commercial |
$110.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.67
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 68180-606-07
|
| 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: 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 Multiplan/Beech St/PHCS |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.54
|
| 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
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$996.23
|
|
|
Service Code
|
NDC 63739-178-30
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$438.34 |
| Max. Negotiated Rate |
$896.61 |
| Rate for Payer: Aetna American Axle |
$647.55
|
| Rate for Payer: Aetna Commercial |
$846.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.55
|
| Rate for Payer: Cash Price |
$796.98
|
| Rate for Payer: Cofinity Commercial |
$697.36
|
| Rate for Payer: Cofinity Commercial |
$856.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.98
|
| Rate for Payer: Healthscope Commercial |
$896.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$697.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$846.80
|
| Rate for Payer: PHP Commercial |
$846.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.36
|
| Rate for Payer: Priority Health SBD |
$627.62
|
| Rate for Payer: UMR Bronson Commercial |
$438.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.17
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
NDC 50268-184-11
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna American Axle |
$13.45
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.45
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$17.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$18.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$13.03
|
| Rate for Payer: UMR Bronson Commercial |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$849.38
|
|
|
Service Code
|
NDC 0904-6467-07
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$373.73 |
| Max. Negotiated Rate |
$764.44 |
| Rate for Payer: Aetna American Axle |
$552.10
|
| Rate for Payer: Aetna Commercial |
$721.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.10
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cofinity Commercial |
$594.57
|
| Rate for Payer: Cofinity Commercial |
$730.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.50
|
| Rate for Payer: Healthscope Commercial |
$764.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$721.97
|
| Rate for Payer: PHP Commercial |
$721.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$594.57
|
| Rate for Payer: Priority Health SBD |
$535.11
|
| Rate for Payer: UMR Bronson Commercial |
$373.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.04
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$413.66
|
|
|
Service Code
|
NDC 50268-184-12
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.01 |
| Max. Negotiated Rate |
$372.29 |
| Rate for Payer: Aetna American Axle |
$268.88
|
| Rate for Payer: Aetna Commercial |
$351.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.88
|
| Rate for Payer: Cash Price |
$330.93
|
| Rate for Payer: Cofinity Commercial |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$355.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.93
|
| Rate for Payer: Healthscope Commercial |
$372.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.61
|
| Rate for Payer: PHP Commercial |
$351.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.56
|
| Rate for Payer: Priority Health SBD |
$260.61
|
| Rate for Payer: UMR Bronson Commercial |
$182.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.24
|
|
|
CLOPIDOGREL 300 MG TABLET
|
Facility
|
IP
|
$1,720.50
|
|
|
Service Code
|
NDC 55111-671-31
|
| Hospital Charge Code |
89346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$757.02 |
| Max. Negotiated Rate |
$1,548.45 |
| Rate for Payer: Aetna American Axle |
$1,118.32
|
| Rate for Payer: Aetna Commercial |
$1,462.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.32
|
| Rate for Payer: Cash Price |
$1,376.40
|
| Rate for Payer: Cofinity Commercial |
$1,204.35
|
| Rate for Payer: Cofinity Commercial |
$1,479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,376.40
|
| Rate for Payer: Healthscope Commercial |
$1,548.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,204.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,290.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,462.42
|
| Rate for Payer: PHP Commercial |
$1,462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.35
|
| Rate for Payer: Priority Health SBD |
$1,083.92
|
| Rate for Payer: UMR Bronson Commercial |
$757.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,290.38
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 0904-6294-61
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$97.29
|
|
|
Service Code
|
NDC 16729-218-15
|
| 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: 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 Multiplan/Beech St/PHCS |
$82.70
|
| Rate for Payer: PHP Commercial |
$82.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.10
|
| 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
|
$208.05
|
|
|
Service Code
|
NDC 0904-6294-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$176.84
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.64
|
| 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
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 68084-536-11
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna American Axle |
$2.74
|
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.74
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.95
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 68084-536-01
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.46
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
IP
|
$1,134.42
|
|
|
Service Code
|
NDC 51672-4042-1
|
| Hospital Charge Code |
1759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.14 |
| Max. Negotiated Rate |
$1,020.98 |
| Rate for Payer: Aetna American Axle |
$737.37
|
| Rate for Payer: Aetna Commercial |
$964.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.37
|
| Rate for Payer: Cash Price |
$907.54
|
| Rate for Payer: Cofinity Commercial |
$794.09
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.54
|
| Rate for Payer: Healthscope Commercial |
$1,020.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$850.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$964.26
|
| Rate for Payer: PHP Commercial |
$964.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.09
|
| Rate for Payer: Priority Health SBD |
$714.68
|
| Rate for Payer: UMR Bronson Commercial |
$499.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$850.82
|
|
|
CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET
|
Facility
|
IP
|
$376.32
|
|
|
Service Code
|
NDC 13107-319-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$319.87
|
| Rate for Payer: PHP Commercial |
$319.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.42
|
| 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
|
|
