|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$32.04
|
|
|
Service Code
|
NDC 00781328909
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.19 |
| Max. Negotiated Rate |
$28.84 |
| Rate for Payer: Aetna Commercial |
$27.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.83
|
| Rate for Payer: Cash Price |
$25.63
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$27.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.23
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.83
|
| Rate for Payer: Priority Health SBD |
$20.19
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$21.03
|
|
|
Service Code
|
NDC 09900000157
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.67
|
| Rate for Payer: Priority Health SBD |
$13.25
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
NDC 59762001601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$385.40
|
|
|
Service Code
|
NDC 23155060351
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 59762001601
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$385.40
|
|
|
Service Code
|
NDC 23155060351
|
| Hospital Charge Code |
37642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.16 |
| Max. Negotiated Rate |
$346.86 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.51
|
| Rate for Payer: BCBS Complete |
$154.16
|
| Rate for Payer: Cash Price |
$308.32
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.32
|
| Rate for Payer: Healthscope Commercial |
$346.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.51
|
| Rate for Payer: Priority Health SBD |
$242.80
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$26.48
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health SBD |
$16.68
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$54.29
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$48.86 |
| Rate for Payer: Aetna Commercial |
$46.15
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna Medicare |
$27.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: BCBS Complete |
$21.72
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Commercial |
$46.69
|
| Rate for Payer: Cofinity Commercial |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$38.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.43
|
| Rate for Payer: Healthscope Commercial |
$48.86
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$46.15
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.29
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$34.20
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$54.29
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$48.86 |
| Rate for Payer: Aetna Commercial |
$46.15
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.29
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cofinity Commercial |
$46.69
|
| Rate for Payer: Cofinity Commercial |
$38.00
|
| Rate for Payer: Cofinity Commercial |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.43
|
| Rate for Payer: Healthscope Commercial |
$48.86
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.15
|
| Rate for Payer: PHP Commercial |
$46.15
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.29
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$34.20
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$26.48
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.21
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$18.54
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.21
|
| Rate for Payer: Priority Health SBD |
$16.68
|
|
|
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 Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| 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: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 42292001820
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.42 |
| 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 Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| 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: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 63304069201
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health SBD |
$170.26
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.67 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.53
|
| Rate for Payer: Cofinity Commercial |
$293.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health SBD |
$214.67
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health SBD |
$130.47
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 63304069201
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.26 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health SBD |
$170.26
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.30 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.53
|
| Rate for Payer: Cofinity Commercial |
$293.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health SBD |
$214.67
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
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 Commercial |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.18
|
| 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: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.95
|
| Rate for Payer: Priority Health SBD |
$2.86
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.47 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health SBD |
$130.47
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 42292001801
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.18
|
| 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: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.95
|
| Rate for Payer: Priority Health SBD |
$2.86
|
|
|
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 Commercial |
$6,725.56
|
| Rate for Payer: Cofinity Commercial |
$8,262.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,725.56
|
| 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: PHP Commercial |
$8,166.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,245.17
|
| 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 |
$3,843.18 |
| 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 Commercial |
$6,725.56
|
| Rate for Payer: Cofinity Commercial |
$8,262.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,725.56
|
| 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: PHP Commercial |
$8,166.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,245.17
|
| Rate for Payer: Priority Health SBD |
$6,053.01
|
|
|
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 Commercial |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.19
|
| 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: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health SBD |
$11.87
|
|
