|
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 |
$176.03
|
| 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
|
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 |
$320.31
|
| 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
|
$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
|
$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 |
$176.03
|
| 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
|
$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 |
$320.31
|
| 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
|
|
|
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 |
$1.03
|
| 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
|
|
|
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
|
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
|
|
|
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
|
|
|
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 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
|
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
|
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 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
|
|
|
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
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: ASR ASR |
$0.93
|
| Rate for Payer: ASR Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| 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: Priority Health HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.84
|
|
|
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 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
|
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
|
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
|
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
|
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 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
|
|
