|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Advantage |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.37
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cofinity Advantage |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.74
|
| Rate for Payer: Healthscope Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.46 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Advantage |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$186.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$194.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.45
|
| Rate for Payer: PHP Commercial |
$184.11
|
| Rate for Payer: Priority Health SBD |
$136.46
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 42292001801
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Advantage |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health SBD |
$2.86
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.12 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna Medicare |
$108.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: BCBS Complete |
$86.64
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Advantage |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$186.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$194.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.45
|
| Rate for Payer: PHP Commercial |
$184.11
|
| Rate for Payer: Priority Health SBD |
$136.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.79
|
| Rate for Payer: UHC Core |
$112.85
|
| Rate for Payer: UHC Exchange |
$85.12
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 42292001820
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.81
|
| Rate for Payer: UHC Core |
$236.30
|
| Rate for Payer: UHC Exchange |
$178.25
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$196.65
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$176.99 |
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Advantage |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$176.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.49
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: Priority Health SBD |
$123.89
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$171.55
|
|
|
Service Code
|
NDC 63304069201
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Aetna Commercial |
$145.82
|
| Rate for Payer: Aetna Medicare |
$85.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.51
|
| Rate for Payer: BCBS Complete |
$68.62
|
| Rate for Payer: Cash Price |
$137.24
|
| Rate for Payer: Cofinity Advantage |
$120.08
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.24
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.66
|
| Rate for Payer: PHP Commercial |
$145.82
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.51
|
| Rate for Payer: UHC Core |
$89.38
|
| Rate for Payer: UHC Exchange |
$67.42
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 42292001820
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.74 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$196.65
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$176.99 |
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna Medicare |
$98.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Advantage |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$176.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.49
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: Priority Health SBD |
$123.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.82
|
| Rate for Payer: UHC Core |
$102.45
|
| Rate for Payer: UHC Exchange |
$77.28
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
IP
|
$9,607.95
|
|
|
Service Code
|
NDC 67386031401
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,053.01 |
| Max. Negotiated Rate |
$8,647.16 |
| Rate for Payer: Aetna Commercial |
$8,166.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,245.17
|
| Rate for Payer: Cash Price |
$7,686.36
|
| Rate for Payer: Cofinity Advantage |
$6,725.56
|
| Rate for Payer: Cofinity Commercial |
$8,262.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,686.36
|
| Rate for Payer: Healthscope Commercial |
$8,647.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,166.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,205.96
|
| Rate for Payer: PHP Commercial |
$8,166.76
|
| Rate for Payer: Priority Health SBD |
$6,053.01
|
|
|
CLOBAZAM 10 MG TABLET
|
Facility
|
OP
|
$9,607.95
|
|
|
Service Code
|
NDC 67386031401
|
| Hospital Charge Code |
150910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,775.92 |
| Max. Negotiated Rate |
$8,647.16 |
| Rate for Payer: Aetna Commercial |
$8,166.76
|
| Rate for Payer: Aetna Medicare |
$4,803.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,245.17
|
| Rate for Payer: BCBS Complete |
$3,843.18
|
| Rate for Payer: Cash Price |
$7,686.36
|
| Rate for Payer: Cofinity Advantage |
$6,725.56
|
| Rate for Payer: Cofinity Commercial |
$8,262.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,686.36
|
| Rate for Payer: Healthscope Commercial |
$8,647.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,686.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,166.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,205.96
|
| Rate for Payer: PHP Commercial |
$8,166.76
|
| Rate for Payer: Priority Health SBD |
$6,053.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,245.17
|
| Rate for Payer: UHC Core |
$5,005.74
|
| Rate for Payer: UHC Exchange |
$3,775.92
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.55
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$16.96
|
| Rate for Payer: UHC Exchange |
$12.79
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 51672125803
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.17 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Advantage |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.63
|
| Rate for Payer: UHC Core |
$67.83
|
| Rate for Payer: UHC Exchange |
$51.17
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 51672125803
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Advantage |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health SBD |
$82.03
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$52.61
|
|
|
Service Code
|
NDC 00168016315
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna Medicare |
$26.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: BCBS Complete |
$21.04
|
| Rate for Payer: Cash Price |
$42.09
|
| Rate for Payer: Cofinity Advantage |
$36.83
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$47.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.46
|
| Rate for Payer: PHP Commercial |
$44.72
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$27.41
|
| Rate for Payer: UHC Exchange |
$20.68
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$52.61
|
|
|
Service Code
|
NDC 00168016315
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna Commercial |
$44.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: Cash Price |
$42.09
|
| Rate for Payer: Cofinity Advantage |
$36.83
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$47.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.46
|
| Rate for Payer: PHP Commercial |
$44.72
|
| Rate for Payer: Priority Health SBD |
$33.14
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$18.84
|
|
|
Service Code
|
NDC 69238153205
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.55
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.51 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.41
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health SBD |
$20.51
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
NDC 69238153205
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.25
|
| Rate for Payer: UHC Core |
$9.82
|
| Rate for Payer: UHC Exchange |
$7.40
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 00093083201
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Advantage |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health SBD |
$30.87
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$7.41
|
|
|
Service Code
|
NDC 60687086111
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.82
|
| Rate for Payer: Cash Price |
$5.93
|
| Rate for Payer: Cofinity Advantage |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$6.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.30
|
| Rate for Payer: Priority Health SBD |
$4.67
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
OP
|
$7.41
|
|
|
Service Code
|
NDC 60687086111
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.82
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: Cash Price |
$5.93
|
| Rate for Payer: Cofinity Advantage |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$6.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.30
|
| Rate for Payer: Priority Health SBD |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.82
|
| Rate for Payer: UHC Core |
$3.86
|
| Rate for Payer: UHC Exchange |
$2.91
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$740.25
|
|
|
Service Code
|
NDC 60687086101
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$466.36 |
| Max. Negotiated Rate |
$666.23 |
| Rate for Payer: Aetna Commercial |
$629.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.16
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cofinity Advantage |
$518.17
|
| Rate for Payer: Cofinity Commercial |
$636.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.20
|
| Rate for Payer: Healthscope Commercial |
$666.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.19
|
| Rate for Payer: PHP Commercial |
$629.21
|
| Rate for Payer: Priority Health SBD |
$466.36
|
|
