|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.52
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: BCN Commercial |
$14.52
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.57
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
183289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.48
|
| Rate for Payer: BCN Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 0781-9221-91
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$18.06
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.57
|
| Rate for Payer: UHC Core |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 0781-9221-09
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$18.06
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.57
|
| Rate for Payer: UHC Core |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$27.75
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Commercial |
$21.45
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$24.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.59
|
| Rate for Payer: PHP Commercial |
$23.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.42
|
| Rate for Payer: UHC Core |
$23.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.81
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$317.86
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$193.86 |
| Max. Negotiated Rate |
$286.07 |
| Rate for Payer: Aetna Commercial |
$270.18
|
| Rate for Payer: BCBS Trust/PPO |
$245.64
|
| Rate for Payer: BCN Commercial |
$245.64
|
| Rate for Payer: Cash Price |
$254.29
|
| Rate for Payer: Cofinity Commercial |
$273.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.29
|
| Rate for Payer: Healthscope Commercial |
$286.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.18
|
| Rate for Payer: PHP Commercial |
$270.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.72
|
| Rate for Payer: UHC Core |
$265.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.40
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$656.45
|
|
|
Service Code
|
NDC 0781-3290-09
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$590.80 |
| Rate for Payer: Aetna Commercial |
$557.98
|
| Rate for Payer: BCBS Trust/PPO |
$507.30
|
| Rate for Payer: BCN Commercial |
$507.30
|
| Rate for Payer: Cash Price |
$525.16
|
| Rate for Payer: Cofinity Commercial |
$564.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.16
|
| Rate for Payer: Healthscope Commercial |
$590.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$557.98
|
| Rate for Payer: PHP Commercial |
$557.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.68
|
| Rate for Payer: UHC Core |
$548.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.34
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$20.47
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Aetna Commercial |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.40
|
| Rate for Payer: PHP Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Core |
$17.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$42.28
|
|
|
Service Code
|
NDC 0781-3290-09
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$38.05 |
| Rate for Payer: Aetna Commercial |
$35.94
|
| Rate for Payer: BCBS Trust/PPO |
$32.67
|
| Rate for Payer: BCN Commercial |
$32.67
|
| Rate for Payer: Cash Price |
$33.82
|
| Rate for Payer: Cofinity Commercial |
$36.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.82
|
| Rate for Payer: Healthscope Commercial |
$38.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.94
|
| Rate for Payer: PHP Commercial |
$35.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.21
|
| Rate for Payer: UHC Core |
$35.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.71
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$27.59
|
|
|
Service Code
|
NDC 0781-9222-09
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.45
|
| Rate for Payer: PHP Commercial |
$23.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.28
|
| Rate for Payer: UHC Core |
$23.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.69
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$27.59
|
|
|
Service Code
|
NDC 0781-9222-91
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: Cofinity Commercial |
$23.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.45
|
| Rate for Payer: PHP Commercial |
$23.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.28
|
| Rate for Payer: UHC Core |
$23.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.69
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 68084-243-11
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 0904-5959-61
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$259.70
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68084-243-01
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna Commercial |
$176.04
|
| Rate for Payer: BCBS Trust/PPO |
$160.05
|
| Rate for Payer: BCN Commercial |
$160.05
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.04
|
| Rate for Payer: PHP Commercial |
$176.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.25
|
| Rate for Payer: UHC Core |
$172.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 63739-059-10
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: BCBS Trust/PPO |
$341.42
|
| Rate for Payer: BCN Commercial |
$341.42
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.53
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.78
|
| Rate for Payer: UHC Core |
$368.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
CLINDAMYCIN IN NS 30 MG/0.5 ML FOR DISCOGRAM
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
NDC 9900-0003-90
|
| Hospital Charge Code |
163511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.76
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$25.10
|
|
|
Service Code
|
NDC 21922-016-05
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.40
|
| Rate for Payer: BCN Commercial |
$19.40
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$21.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$22.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.34
|
| Rate for Payer: PHP Commercial |
$21.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.09
|
| Rate for Payer: UHC Core |
$20.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.82
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
NDC 51672-1258-2
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$50.31
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$55.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.34
|
| Rate for Payer: PHP Commercial |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.29
|
| Rate for Payer: UHC Core |
$54.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.82
|
|
|
CLONAZEPAM 0.25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 9900-0003-54
|
| Hospital Charge Code |
158588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna Commercial |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cofinity Commercial |
$0.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$0.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.55
|
| Rate for Payer: PHP Commercial |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.49
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$250.56
|
|
|
Service Code
|
NDC 57664-784-86
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.82 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna Commercial |
$212.98
|
| Rate for Payer: BCBS Trust/PPO |
$193.63
|
| Rate for Payer: BCN Commercial |
$193.63
|
| Rate for Payer: Cash Price |
$200.45
|
| Rate for Payer: Cofinity Commercial |
$215.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.98
|
| Rate for Payer: PHP Commercial |
$212.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.49
|
| Rate for Payer: UHC Core |
$209.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.92
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$154.66
|
|
|
Service Code
|
NDC 49884-307-02
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.46
|
| Rate for Payer: BCBS Trust/PPO |
$119.52
|
| Rate for Payer: BCN Commercial |
$119.52
|
| Rate for Payer: Cash Price |
$123.73
|
| Rate for Payer: Cofinity Commercial |
$133.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.73
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.46
|
| Rate for Payer: PHP Commercial |
$131.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.10
|
| Rate for Payer: UHC Core |
$129.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.00
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 49884-307-52
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 43547-406-10
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: BCBS Trust/PPO |
$50.04
|
| Rate for Payer: BCN Commercial |
$50.04
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 63739-263-10
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$63.56
|
| Rate for Payer: BCN Commercial |
$63.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
CLONAZEPAM 0.5 MG TABLET
|
Facility
|
IP
|
$666.75
|
|
|
Service Code
|
NDC 0904-7227-61
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.65 |
| Max. Negotiated Rate |
$600.08 |
| Rate for Payer: Aetna Commercial |
$566.74
|
| Rate for Payer: BCBS Trust/PPO |
$515.26
|
| Rate for Payer: BCN Commercial |
$515.26
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Commercial |
$573.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$600.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$566.74
|
| Rate for Payer: PHP Commercial |
$566.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.74
|
| Rate for Payer: UHC Core |
$556.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.06
|
|
