|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$82.84
|
|
|
Service Code
|
NDC 70700-109-16
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.99 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: ASR ASR |
$80.35
|
| Rate for Payer: BCBS Trust/PPO |
$64.23
|
| 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 Multiplan/Beech St/PHCS |
$70.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.90
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.27
|
|
|
Service Code
|
NDC 51672-1259-6
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: ASR ASR |
$37.12
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$29.67
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.62
|
| Rate for Payer: Healthscope Commercial |
$38.27
|
| Rate for Payer: Healthscope Whirlpool |
$37.12
|
| Rate for Payer: Mclaren Commercial |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.68
|
|
|
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 |
$108.26 |
| Max. Negotiated Rate |
$154.66 |
| Rate for Payer: Aetna Commercial |
$139.19
|
| Rate for Payer: ASR ASR |
$150.02
|
| Rate for Payer: BCBS Trust/PPO |
$119.91
|
| Rate for Payer: BCN Commercial |
$119.91
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.73
|
| Rate for Payer: Healthscope Commercial |
$154.66
|
| Rate for Payer: Healthscope Whirlpool |
$150.02
|
| Rate for Payer: Mclaren Commercial |
$139.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.10
|
|
|
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 |
$1.81 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: ASR ASR |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Healthscope Whirlpool |
$2.50
|
| Rate for Payer: Mclaren Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.27
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 51079-882-01
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: ASR ASR |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| 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 Multiplan/Beech St/PHCS |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.84
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
NDC 43547-407-10
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: ASR ASR |
$81.48
|
| Rate for Payer: BCBS Trust/PPO |
$65.13
|
| 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 Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.92
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,004.40
|
|
|
Service Code
|
NDC 0597-0031-34
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Aetna Commercial |
$903.96
|
| Rate for Payer: ASR ASR |
$974.27
|
| Rate for Payer: BCBS Trust/PPO |
$778.71
|
| 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 Multiplan/Beech St/PHCS |
$853.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.87
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$118.67
|
|
|
Service Code
|
NDC 0378-0871-99
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$118.67 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: ASR ASR |
$115.11
|
| Rate for Payer: BCBS Trust/PPO |
$92.00
|
| Rate for Payer: BCN Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$94.93
|
| Rate for Payer: Cofinity Commercial |
$111.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.94
|
| Rate for Payer: Healthscope Commercial |
$118.67
|
| Rate for Payer: Healthscope Whirlpool |
$115.11
|
| Rate for Payer: Mclaren Commercial |
$106.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.43
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$29.67
|
|
|
Service Code
|
NDC 0378-0871-16
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$29.67 |
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: ASR ASR |
$28.78
|
| Rate for Payer: BCBS Trust/PPO |
$23.00
|
| Rate for Payer: BCN Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$23.73
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$29.67
|
| Rate for Payer: Healthscope Whirlpool |
$28.78
|
| Rate for Payer: Mclaren Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.11
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$254.60
|
|
|
Service Code
|
NDC 60687-113-01
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: ASR ASR |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$197.39
|
| Rate for Payer: BCN Commercial |
$197.39
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$239.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$254.60
|
| Rate for Payer: Healthscope Whirlpool |
$246.96
|
| Rate for Payer: Mclaren Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.05
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 0228-2127-10
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.51 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna Commercial |
$80.37
|
| Rate for Payer: ASR ASR |
$86.62
|
| Rate for Payer: BCBS Trust/PPO |
$69.23
|
| Rate for Payer: BCN Commercial |
$69.23
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$89.30
|
| Rate for Payer: Healthscope Whirlpool |
$86.62
|
| Rate for Payer: Mclaren Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.58
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Healthscope Whirlpool |
$2.47
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION
|
Facility
|
IP
|
$274.61
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.23 |
| Max. Negotiated Rate |
$274.61 |
| Rate for Payer: Aetna Commercial |
$247.15
|
| Rate for Payer: Aetna Commercial |
$172.91
|
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Commercial |
$209.32
|
| Rate for Payer: ASR ASR |
$225.60
|
| Rate for Payer: ASR ASR |
$186.36
|
| Rate for Payer: ASR ASR |
$266.37
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: BCBS Trust/PPO |
$210.11
|
| Rate for Payer: BCBS Trust/PPO |
$212.91
|
| Rate for Payer: BCBS Trust/PPO |
$148.95
|
| Rate for Payer: BCBS Trust/PPO |
$180.32
|
| Rate for Payer: BCN Commercial |
$210.11
|
| Rate for Payer: BCN Commercial |
$148.95
|
| Rate for Payer: BCN Commercial |
$180.32
|
| Rate for Payer: BCN Commercial |
$212.91
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$153.70
|
| Rate for Payer: Cash Price |
$219.69
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Cofinity Commercial |
$258.13
|
| Rate for Payer: Cofinity Commercial |
$180.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.69
|
| Rate for Payer: Healthscope Commercial |
$271.00
|
| Rate for Payer: Healthscope Commercial |
$192.12
|
| Rate for Payer: Healthscope Commercial |
$232.58
|
| Rate for Payer: Healthscope Commercial |
$274.61
|
| Rate for Payer: Healthscope Whirlpool |
$186.36
|
| Rate for Payer: Healthscope Whirlpool |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$266.37
|
| Rate for Payer: Healthscope Whirlpool |
$262.87
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Mclaren Commercial |
$172.91
|
| Rate for Payer: Mclaren Commercial |
$209.32
|
| Rate for Payer: Mclaren Commercial |
$247.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.07
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 68084-536-01
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.46 |
| Max. Negotiated Rate |
$420.65 |
| Rate for Payer: Aetna Commercial |
$378.58
|
| Rate for Payer: ASR ASR |
$408.03
|
| Rate for Payer: BCBS Trust/PPO |
$326.13
|
| Rate for Payer: BCN Commercial |
$326.13
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$395.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$420.65
|
| Rate for Payer: Healthscope Whirlpool |
$408.03
|
| Rate for Payer: Mclaren Commercial |
$378.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.17
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 0904-6294-61
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.66 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.98
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$253.25
|
| Rate for Payer: BCN Commercial |
$253.25
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$326.65
|
| Rate for Payer: Healthscope Whirlpool |
$316.85
|
| Rate for Payer: Mclaren Commercial |
$293.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 68084-536-11
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: ASR ASR |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Healthscope Whirlpool |
$4.08
|
| Rate for Payer: Mclaren Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.70
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.26
|
|
|
Service Code
|
NDC 0536-1272-22
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: ASR ASR |
$10.92
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.01
|
| Rate for Payer: Healthscope Commercial |
$11.26
|
| Rate for Payer: Healthscope Whirlpool |
$10.92
|
| Rate for Payer: Mclaren Commercial |
$10.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.91
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
NDC 45802-434-11
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$17.50
|
| Rate for Payer: ASR ASR |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCN Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Healthscope Commercial |
$19.44
|
| Rate for Payer: Healthscope Whirlpool |
$18.86
|
| Rate for Payer: Mclaren Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.11
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462-298-17
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: ASR ASR |
$18.92
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Whirlpool |
$18.92
|
| Rate for Payer: Mclaren Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.17
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.91
|
|
|
Service Code
|
NDC 0168-0258-15
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Aetna Commercial |
$17.92
|
| Rate for Payer: ASR ASR |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Whirlpool |
$19.31
|
| Rate for Payer: Mclaren Commercial |
$17.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.52
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.92
|
|
|
Service Code
|
NDC 0472-0379-15
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: ASR ASR |
$31.93
|
| Rate for Payer: BCBS Trust/PPO |
$25.52
|
| Rate for Payer: BCN Commercial |
$25.52
|
| Rate for Payer: Cash Price |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Whirlpool |
$31.93
|
| Rate for Payer: Mclaren Commercial |
$29.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.97
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$20,030.40
|
|
|
Service Code
|
MS-DRG 813
|
| Min. Negotiated Rate |
$14,144.08 |
| Max. Negotiated Rate |
$20,030.40 |
| Rate for Payer: Aetna Medicare |
$14,888.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,610.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,610.64
|
| Rate for Payer: BCBS MAPPO |
$14,888.51
|
| Rate for Payer: BCN Medicare Advantage |
$14,888.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,888.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,888.51
|
| Rate for Payer: Mclaren Medicare |
$14,888.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,632.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,121.79
|
| Rate for Payer: PACE Medicare |
$14,144.08
|
| Rate for Payer: PACE SWMI |
$14,888.51
|
| Rate for Payer: PHP Commercial |
$16,377.36
|
| Rate for Payer: PHP Medicare Advantage |
$14,888.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,030.40
|
| Rate for Payer: Priority Health Medicare |
$14,888.51
|
| Rate for Payer: Priority Health Narrow Network |
$16,024.32
|
| Rate for Payer: Railroad Medicare Medicare |
$14,888.51
|
| Rate for Payer: UHC Medicare Advantage |
$15,335.17
|
| Rate for Payer: VA VA |
$14,888.51
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$20.45
|
|
|
Service Code
|
NDC 60687-358-95
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: ASR ASR |
$19.84
|
| Rate for Payer: BCBS Trust/PPO |
$15.85
|
| Rate for Payer: BCN Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Whirlpool |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$613.50
|
|
|
Service Code
|
NDC 60687-358-25
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.45 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$552.15
|
| Rate for Payer: ASR ASR |
$595.10
|
| Rate for Payer: BCBS Trust/PPO |
$475.65
|
| Rate for Payer: BCN Commercial |
$475.65
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cofinity Commercial |
$576.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.80
|
| Rate for Payer: Healthscope Commercial |
$613.50
|
| Rate for Payer: Healthscope Whirlpool |
$595.10
|
| Rate for Payer: Mclaren Commercial |
$552.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$521.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.88
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$469.31
|
|
|
Service Code
|
NDC 0904-6732-04
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.52 |
| Max. Negotiated Rate |
$469.31 |
| Rate for Payer: Aetna Commercial |
$422.38
|
| Rate for Payer: ASR ASR |
$455.23
|
| Rate for Payer: BCBS Trust/PPO |
$363.86
|
| Rate for Payer: BCN Commercial |
$363.86
|
| Rate for Payer: Cash Price |
$375.45
|
| Rate for Payer: Cofinity Commercial |
$441.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.45
|
| Rate for Payer: Healthscope Commercial |
$469.31
|
| Rate for Payer: Healthscope Whirlpool |
$455.23
|
| Rate for Payer: Mclaren Commercial |
$422.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.99
|
|
