|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 17478071425
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: ASR ASR |
$23.76
|
| Rate for Payer: ASR Commercial |
$23.76
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$24.50
|
| Rate for Payer: Healthscope Whirlpool |
$23.76
|
| Rate for Payer: Mclaren Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.56
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.42
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$373.43
|
| Rate for Payer: BCN Commercial |
$355.28
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| Rate for Payer: Mclaren Commercial |
$412.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.42
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: ASR Commercial |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$375.26
|
| Rate for Payer: BCN Commercial |
$355.28
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$458.25
|
| Rate for Payer: Healthscope Whirlpool |
$444.50
|
| Rate for Payer: Mclaren Commercial |
$412.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: ASR ASR |
$12.77
|
| Rate for Payer: ASR Commercial |
$12.77
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$13.16
|
| Rate for Payer: Healthscope Whirlpool |
$12.77
|
| Rate for Payer: Mclaren Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$9.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.58
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna Commercial |
$11.84
|
| Rate for Payer: ASR ASR |
$12.77
|
| Rate for Payer: ASR Commercial |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$13.16
|
| Rate for Payer: Healthscope Whirlpool |
$12.77
|
| Rate for Payer: Mclaren Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.19
|
| Rate for Payer: Nomi Health Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.58
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.19
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.67
|
| Rate for Payer: Priority Health Narrow Network |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.19
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: ASR Commercial |
$41.44
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$34.98
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$42.72
|
| Rate for Payer: Healthscope Whirlpool |
$41.44
|
| Rate for Payer: Mclaren Commercial |
$38.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.67
|
| Rate for Payer: Priority Health Narrow Network |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: ASR Commercial |
$41.44
|
| Rate for Payer: BCBS Trust/PPO |
$34.81
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$42.72
|
| Rate for Payer: Healthscope Whirlpool |
$41.44
|
| Rate for Payer: Mclaren Commercial |
$38.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: ASR ASR |
$2.01
|
| Rate for Payer: ASR Commercial |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Healthscope Whirlpool |
$2.01
|
| Rate for Payer: Mclaren Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.82
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.49 |
| Max. Negotiated Rate |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: ASR Commercial |
$330.53
|
| Rate for Payer: BCBS Trust/PPO |
$277.68
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: ASR ASR |
$200.89
|
| Rate for Payer: ASR Commercial |
$200.89
|
| Rate for Payer: BCBS Trust/PPO |
$168.77
|
| Rate for Payer: BCN Commercial |
$160.56
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$194.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$207.10
|
| Rate for Payer: Healthscope Whirlpool |
$200.89
|
| Rate for Payer: Mclaren Commercial |
$186.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.04
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.25
|
|
|
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 |
$207.10 |
| Rate for Payer: Aetna Commercial |
$186.39
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: ASR ASR |
$200.89
|
| Rate for Payer: ASR Commercial |
$200.89
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.59
|
| Rate for Payer: BCN Commercial |
$160.56
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$194.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$207.10
|
| Rate for Payer: Healthscope Whirlpool |
$200.89
|
| Rate for Payer: Mclaren Commercial |
$186.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.04
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.46
|
| Rate for Payer: Priority Health Narrow Network |
$145.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.25
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.86
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.01
|
| Rate for Payer: ASR Commercial |
$2.01
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Healthscope Whirlpool |
$2.01
|
| Rate for Payer: Mclaren Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.81
|
| Rate for Payer: Priority Health Narrow Network |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.82
|
|
|
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 |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: ASR Commercial |
$330.53
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: BCBS Trust/PPO |
$279.04
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Nomi Health Commercial |
$279.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.57
|
| Rate for Payer: Priority Health Narrow Network |
$238.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$82.84
|
|
|
Service Code
|
NDC 70700010916
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$41.42
|
| Rate for Payer: ASR ASR |
$80.35
|
| Rate for Payer: ASR Commercial |
$80.35
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: BCBS Trust/PPO |
$67.84
|
| Rate for Payer: BCN Commercial |
$64.23
|
| Rate for Payer: Cash Price |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$77.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$82.84
|
| Rate for Payer: Healthscope Whirlpool |
$80.35
|
| Rate for Payer: Mclaren Commercial |
$74.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.41
|
| Rate for Payer: Nomi Health Commercial |
$67.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.58
|
| Rate for Payer: Priority Health Narrow Network |
$58.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.90
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$82.84
|
|
|
Service Code
|
NDC 70700010916
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: ASR ASR |
$80.35
|
| Rate for Payer: ASR Commercial |
$80.35
|
| Rate for Payer: BCBS Trust/PPO |
$67.51
|
| Rate for Payer: BCN Commercial |
$64.23
|
| Rate for Payer: Cash Price |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$77.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$82.84
|
| Rate for Payer: Healthscope Whirlpool |
$80.35
|
| Rate for Payer: Mclaren Commercial |
$74.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.41
|
| Rate for Payer: Nomi Health Commercial |
$67.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.90
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$39.22
|
|
|
Service Code
|
NDC 51672125906
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$39.22 |
| Rate for Payer: Aetna Commercial |
$35.30
|
| Rate for Payer: ASR ASR |
$38.04
|
| Rate for Payer: ASR Commercial |
$38.04
|
| Rate for Payer: BCBS Trust/PPO |
$31.96
|
| Rate for Payer: BCN Commercial |
$30.41
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$36.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.38
|
| Rate for Payer: Healthscope Commercial |
$39.22
|
| Rate for Payer: Healthscope Whirlpool |
$38.04
|
| Rate for Payer: Mclaren Commercial |
$35.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.34
|
| Rate for Payer: Nomi Health Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.51
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$39.22
|
|
|
Service Code
|
NDC 51672125906
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$39.22 |
| Rate for Payer: Aetna Commercial |
$35.30
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: ASR ASR |
$38.04
|
| Rate for Payer: ASR Commercial |
$38.04
|
| Rate for Payer: BCBS Complete |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$32.12
|
| Rate for Payer: BCN Commercial |
$30.41
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$36.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.38
|
| Rate for Payer: Healthscope Commercial |
$39.22
|
| Rate for Payer: Healthscope Whirlpool |
$38.04
|
| Rate for Payer: Mclaren Commercial |
$35.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.34
|
| Rate for Payer: Nomi Health Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.36
|
| Rate for Payer: Priority Health Narrow Network |
$27.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.51
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.84
|
| Rate for Payer: Priority Health Narrow Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$194.11
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.17 |
| Max. Negotiated Rate |
$194.11 |
| Rate for Payer: Aetna Commercial |
$174.70
|
| Rate for Payer: ASR ASR |
$188.29
|
| Rate for Payer: ASR Commercial |
$188.29
|
| Rate for Payer: BCBS Trust/PPO |
$158.18
|
| Rate for Payer: BCN Commercial |
$150.49
|
| Rate for Payer: Cash Price |
$155.29
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.29
|
| Rate for Payer: Healthscope Commercial |
$194.11
|
| Rate for Payer: Healthscope Whirlpool |
$188.29
|
| Rate for Payer: Mclaren Commercial |
$174.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.99
|
| Rate for Payer: Nomi Health Commercial |
$159.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.82
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$194.11
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.64 |
| Max. Negotiated Rate |
$194.11 |
| Rate for Payer: Aetna Commercial |
$174.70
|
| Rate for Payer: Aetna Medicare |
$97.06
|
| Rate for Payer: ASR ASR |
$188.29
|
| Rate for Payer: ASR Commercial |
$188.29
|
| Rate for Payer: BCBS Complete |
$77.64
|
| Rate for Payer: BCBS Trust/PPO |
$158.96
|
| Rate for Payer: BCN Commercial |
$150.49
|
| Rate for Payer: Cash Price |
$155.29
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.29
|
| Rate for Payer: Healthscope Commercial |
$194.11
|
| Rate for Payer: Healthscope Whirlpool |
$188.29
|
| Rate for Payer: Mclaren Commercial |
$174.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.99
|
| Rate for Payer: Nomi Health Commercial |
$159.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.08
|
| Rate for Payer: Priority Health Narrow Network |
$136.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.82
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: ASR ASR |
$0.93
|
| Rate for Payer: ASR Commercial |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cofinity Commercial |
$0.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$0.96
|
| Rate for Payer: Healthscope Whirlpool |
$0.93
|
| Rate for Payer: Mclaren Commercial |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.82
|
| Rate for Payer: Nomi Health Commercial |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.84
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: ASR ASR |
$81.48
|
| Rate for Payer: ASR Commercial |
$81.48
|
| Rate for Payer: BCBS Trust/PPO |
$68.45
|
| Rate for Payer: BCN Commercial |
$65.13
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$84.00
|
| Rate for Payer: Healthscope Whirlpool |
$81.48
|
| Rate for Payer: Mclaren Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.40
|
| Rate for Payer: Nomi Health Commercial |
$68.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.92
|
|
