|
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
|
OP
|
$84.00
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: ASR ASR |
$81.48
|
| Rate for Payer: ASR Commercial |
$81.48
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS Trust/PPO |
$68.79
|
| 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: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Narrow Network |
$58.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.92
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$364.72
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$328.25
|
| Rate for Payer: Aetna Medicare |
$182.36
|
| Rate for Payer: ASR ASR |
$353.78
|
| Rate for Payer: ASR Commercial |
$353.78
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: BCBS Trust/PPO |
$298.67
|
| Rate for Payer: BCN Commercial |
$282.77
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cofinity Commercial |
$342.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Healthscope Whirlpool |
$353.78
|
| Rate for Payer: Mclaren Commercial |
$328.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Nomi Health Commercial |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.57
|
| Rate for Payer: Priority Health Narrow Network |
$255.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.95
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,004.40
|
|
|
Service Code
|
NDC 00597003134
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.76 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Aetna Commercial |
$903.96
|
| Rate for Payer: Aetna Medicare |
$502.20
|
| Rate for Payer: ASR ASR |
$974.27
|
| Rate for Payer: ASR Commercial |
$974.27
|
| Rate for Payer: BCBS Complete |
$401.76
|
| Rate for Payer: BCBS Trust/PPO |
$822.50
|
| Rate for Payer: BCN Commercial |
$778.71
|
| Rate for Payer: Cash Price |
$803.52
|
| Rate for Payer: Cofinity Commercial |
$944.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.52
|
| Rate for Payer: Healthscope Commercial |
$1,004.40
|
| Rate for Payer: Healthscope Whirlpool |
$974.27
|
| Rate for Payer: Mclaren Commercial |
$903.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.74
|
| Rate for Payer: Nomi Health Commercial |
$823.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$880.06
|
| Rate for Payer: Priority Health Narrow Network |
$704.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.87
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,004.40
|
|
|
Service Code
|
NDC 00597003134
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$652.86 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Aetna Commercial |
$903.96
|
| Rate for Payer: ASR ASR |
$974.27
|
| Rate for Payer: ASR Commercial |
$974.27
|
| Rate for Payer: BCBS Trust/PPO |
$818.49
|
| Rate for Payer: BCN Commercial |
$778.71
|
| Rate for Payer: Cash Price |
$803.52
|
| Rate for Payer: Cofinity Commercial |
$944.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.52
|
| Rate for Payer: Healthscope Commercial |
$1,004.40
|
| Rate for Payer: Healthscope Whirlpool |
$974.27
|
| Rate for Payer: Mclaren Commercial |
$903.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.74
|
| Rate for Payer: Nomi Health Commercial |
$823.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.87
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$364.72
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$328.25
|
| Rate for Payer: ASR ASR |
$353.78
|
| Rate for Payer: ASR Commercial |
$353.78
|
| Rate for Payer: BCBS Trust/PPO |
$297.21
|
| Rate for Payer: BCN Commercial |
$282.77
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cofinity Commercial |
$342.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.78
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Healthscope Whirlpool |
$353.78
|
| Rate for Payer: Mclaren Commercial |
$328.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Nomi Health Commercial |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.95
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$91.18
|
|
|
Service Code
|
NDC 00378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna Commercial |
$82.06
|
| Rate for Payer: ASR ASR |
$88.44
|
| Rate for Payer: ASR Commercial |
$88.44
|
| Rate for Payer: BCBS Trust/PPO |
$74.30
|
| Rate for Payer: BCN Commercial |
$70.69
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$85.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$91.18
|
| Rate for Payer: Healthscope Whirlpool |
$88.44
|
| Rate for Payer: Mclaren Commercial |
$82.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$74.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.24
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$91.18
|
|
|
Service Code
|
NDC 00378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna Commercial |
$82.06
|
| Rate for Payer: Aetna Medicare |
$45.59
|
| Rate for Payer: ASR ASR |
$88.44
|
| Rate for Payer: ASR Commercial |
$88.44
|
| Rate for Payer: BCBS Complete |
$36.47
|
| Rate for Payer: BCBS Trust/PPO |
$74.67
|
| Rate for Payer: BCN Commercial |
$70.69
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$85.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$91.18
|
| Rate for Payer: Healthscope Whirlpool |
$88.44
|
| Rate for Payer: Mclaren Commercial |
$82.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$74.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.89
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.24
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Aetna Commercial |
$257.36
|
| Rate for Payer: ASR ASR |
$277.37
|
| Rate for Payer: ASR Commercial |
$277.37
|
| Rate for Payer: BCBS Trust/PPO |
$233.02
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$285.95
|
| Rate for Payer: Healthscope Whirlpool |
$277.37
|
| Rate for Payer: Mclaren Commercial |
$257.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.64
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$234.27
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: ASR ASR |
$252.49
|
| Rate for Payer: ASR Commercial |
$252.49
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: BCBS Trust/PPO |
$213.16
|
| Rate for Payer: BCN Commercial |
$201.81
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$244.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$260.30
|
| Rate for Payer: Healthscope Whirlpool |
$252.49
|
| Rate for Payer: Mclaren Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.26
|
| Rate for Payer: Nomi Health Commercial |
$213.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.07
|
| Rate for Payer: Priority Health Narrow Network |
$182.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.06
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: ASR ASR |
$2.77
|
| Rate for Payer: ASR Commercial |
$2.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 00904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$234.27
|
| Rate for Payer: ASR ASR |
$252.49
|
| Rate for Payer: ASR Commercial |
$252.49
|
| Rate for Payer: BCBS Trust/PPO |
$212.12
|
| Rate for Payer: BCN Commercial |
$201.81
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$244.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$260.30
|
| Rate for Payer: Healthscope Whirlpool |
$252.49
|
| Rate for Payer: Mclaren Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.26
|
| Rate for Payer: Nomi Health Commercial |
$213.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.06
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$82.48
|
| Rate for Payer: Aetna Medicare |
$45.82
|
| Rate for Payer: ASR ASR |
$88.90
|
| Rate for Payer: ASR Commercial |
$88.90
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: BCBS Trust/PPO |
$75.05
|
| Rate for Payer: BCN Commercial |
$71.06
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$86.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$91.65
|
| Rate for Payer: Healthscope Whirlpool |
$88.90
|
| Rate for Payer: Mclaren Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.30
|
| Rate for Payer: Priority Health Narrow Network |
$64.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.65
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Aetna Commercial |
$257.36
|
| Rate for Payer: Aetna Medicare |
$142.98
|
| Rate for Payer: ASR ASR |
$277.37
|
| Rate for Payer: ASR Commercial |
$277.37
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: BCBS Trust/PPO |
$234.16
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$285.95
|
| Rate for Payer: Healthscope Whirlpool |
$277.37
|
| Rate for Payer: Mclaren Commercial |
$257.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.55
|
| Rate for Payer: Priority Health Narrow Network |
$200.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.64
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$82.48
|
| Rate for Payer: ASR ASR |
$88.90
|
| Rate for Payer: ASR Commercial |
$88.90
|
| Rate for Payer: BCBS Trust/PPO |
$74.69
|
| Rate for Payer: BCN Commercial |
$71.06
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$86.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$91.65
|
| Rate for Payer: Healthscope Whirlpool |
$88.90
|
| Rate for Payer: Mclaren Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.65
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: ASR ASR |
$2.77
|
| Rate for Payer: ASR Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Commercial |
$209.32
|
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Aetna Commercial |
$206.32
|
| Rate for Payer: Aetna Medicare |
$116.29
|
| Rate for Payer: Aetna Medicare |
$80.84
|
| Rate for Payer: Aetna Medicare |
$114.62
|
| Rate for Payer: Aetna Medicare |
$135.50
|
| Rate for Payer: ASR ASR |
$156.83
|
| Rate for Payer: ASR ASR |
$222.36
|
| Rate for Payer: ASR ASR |
$225.60
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: ASR Commercial |
$225.60
|
| Rate for Payer: ASR Commercial |
$262.87
|
| Rate for Payer: ASR Commercial |
$222.36
|
| Rate for Payer: BCBS Complete |
$93.03
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS Complete |
$64.67
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$221.92
|
| Rate for Payer: BCBS Trust/PPO |
$187.72
|
| Rate for Payer: BCBS Trust/PPO |
$132.40
|
| Rate for Payer: BCBS Trust/PPO |
$190.46
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: BCN Commercial |
$210.11
|
| Rate for Payer: BCN Commercial |
$177.73
|
| Rate for Payer: BCN Commercial |
$180.32
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$215.49
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$271.00
|
| Rate for Payer: Healthscope Commercial |
$229.24
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$232.58
|
| Rate for Payer: Healthscope Whirlpool |
$222.36
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Healthscope Whirlpool |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$262.87
|
| Rate for Payer: Mclaren Commercial |
$209.32
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Commercial |
$206.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$187.98
|
| Rate for Payer: Nomi Health Commercial |
$190.72
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
| Rate for Payer: Priority Health Narrow Network |
$13.45
|
| Rate for Payer: Priority Health Narrow Network |
$13.45
|
| Rate for Payer: Priority Health Narrow Network |
$13.45
|
| Rate for Payer: Priority Health Narrow Network |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.73
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION
|
Facility
|
IP
|
$161.68
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Commercial |
$206.32
|
| Rate for Payer: Aetna Commercial |
$209.32
|
| Rate for Payer: ASR ASR |
$225.60
|
| Rate for Payer: ASR ASR |
$222.36
|
| Rate for Payer: ASR ASR |
$156.83
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: ASR Commercial |
$225.60
|
| Rate for Payer: ASR Commercial |
$222.36
|
| Rate for Payer: ASR Commercial |
$156.83
|
| Rate for Payer: ASR Commercial |
$262.87
|
| Rate for Payer: BCBS Trust/PPO |
$131.75
|
| Rate for Payer: BCBS Trust/PPO |
$220.84
|
| Rate for Payer: BCBS Trust/PPO |
$186.81
|
| Rate for Payer: BCBS Trust/PPO |
$189.53
|
| Rate for Payer: BCN Commercial |
$210.11
|
| Rate for Payer: BCN Commercial |
$125.35
|
| Rate for Payer: BCN Commercial |
$177.73
|
| Rate for Payer: BCN Commercial |
$180.32
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Cofinity Commercial |
$151.98
|
| Rate for Payer: Cofinity Commercial |
$215.49
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.39
|
| Rate for Payer: Healthscope Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$229.24
|
| Rate for Payer: Healthscope Commercial |
$232.58
|
| Rate for Payer: Healthscope Commercial |
$271.00
|
| Rate for Payer: Healthscope Whirlpool |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$156.83
|
| Rate for Payer: Healthscope Whirlpool |
$262.87
|
| Rate for Payer: Healthscope Whirlpool |
$222.36
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Commercial |
$209.32
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Mclaren Commercial |
$206.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.69
|
| Rate for Payer: Nomi Health Commercial |
$190.72
|
| Rate for Payer: Nomi Health Commercial |
$187.98
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Nomi Health Commercial |
$132.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.67
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.91
|
| Rate for Payer: Priority Health Narrow Network |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$331.00
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$283.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.22 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: ASR ASR |
$433.10
|
| Rate for Payer: ASR Commercial |
$433.10
|
| Rate for Payer: BCBS Trust/PPO |
$363.85
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.10
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Nomi Health Commercial |
$366.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: ASR ASR |
$433.10
|
| Rate for Payer: ASR Commercial |
$433.10
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$365.64
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.10
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: Nomi Health Commercial |
$366.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.22
|
| Rate for Payer: Priority Health Narrow Network |
$313.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$329.38
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.26
|
| Rate for Payer: ASR ASR |
$8.90
|
| Rate for Payer: ASR Commercial |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.08
|
|
