|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
NDC 143926801
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 143926801
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
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 |
$32.04 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$35.08
|
| 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 |
$41.44
|
| Rate for Payer: Healthscope Whirlpool |
$42.72
|
| 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: Opus (Opus Packaging Group) HMA |
$32.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Aetna Commercial |
$38.45
|
| Rate for Payer: Aetna Medicare |
$15.81
|
| Rate for Payer: ASR ASR |
$41.44
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$35.22
|
| 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 |
$41.44
|
| Rate for Payer: Healthscope Whirlpool |
$42.72
|
| Rate for Payer: Mclaren Commercial |
$38.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.99
|
| Rate for Payer: Priority Health Narrow Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.59
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$16.28
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: ASR ASR |
$15.79
|
| Rate for Payer: BCBS Trust/PPO |
$13.37
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Commercial |
$15.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Whirlpool |
$16.28
|
| Rate for Payer: Mclaren Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$13.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.33
|
|
|
CLINDAMYCIN 900 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$16.28
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
300022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$6.02
|
| Rate for Payer: ASR ASR |
$15.79
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Commercial |
$15.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Whirlpool |
$16.28
|
| Rate for Payer: Mclaren Commercial |
$14.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$13.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.99
|
| Rate for Payer: Priority Health Narrow Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.33
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$194.94
|
| Rate for Payer: Aetna Medicare |
$80.14
|
| Rate for Payer: ASR ASR |
$210.10
|
| Rate for Payer: BCBS Complete |
$86.64
|
| Rate for Payer: BCBS Trust/PPO |
$178.59
|
| Rate for Payer: BCN Commercial |
$178.59
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$210.10
|
| Rate for Payer: Healthscope Whirlpool |
$216.60
|
| Rate for Payer: Mclaren Commercial |
$194.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.11
|
| Rate for Payer: Nomi Health Commercial |
$177.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.78
|
| Rate for Payer: Priority Health Narrow Network |
$151.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.61
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$216.60
|
|
|
Service Code
|
NDC 68084024301
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.45 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$194.94
|
| Rate for Payer: ASR ASR |
$210.10
|
| Rate for Payer: BCBS Trust/PPO |
$177.87
|
| Rate for Payer: BCN Commercial |
$177.87
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$210.10
|
| Rate for Payer: Healthscope Whirlpool |
$216.60
|
| Rate for Payer: Mclaren Commercial |
$194.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.11
|
| Rate for Payer: Nomi Health Commercial |
$177.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.61
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$196.65
|
|
|
Service Code
|
NDC 904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$176.99
|
| Rate for Payer: Aetna Medicare |
$72.76
|
| Rate for Payer: ASR ASR |
$190.75
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS Trust/PPO |
$162.14
|
| Rate for Payer: BCN Commercial |
$162.14
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Commercial |
$184.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$190.75
|
| Rate for Payer: Healthscope Whirlpool |
$196.65
|
| Rate for Payer: Mclaren Commercial |
$176.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.15
|
| Rate for Payer: Nomi Health Commercial |
$161.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.30
|
| Rate for Payer: Priority Health Narrow Network |
$137.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.05
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.90
|
| Rate for Payer: Priority Health Narrow Network |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.91
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 68084024311
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.91
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE
|
Facility
|
IP
|
$196.65
|
|
|
Service Code
|
NDC 904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$176.99
|
| Rate for Payer: ASR ASR |
$190.75
|
| Rate for Payer: BCBS Trust/PPO |
$161.49
|
| Rate for Payer: BCN Commercial |
$161.49
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Commercial |
$184.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$190.75
|
| Rate for Payer: Healthscope Whirlpool |
$196.65
|
| Rate for Payer: Mclaren Commercial |
$176.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.15
|
| Rate for Payer: Nomi Health Commercial |
$161.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.05
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$81.06
|
|
|
Service Code
|
NDC 70700010916
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$72.95
|
| Rate for Payer: ASR ASR |
$78.63
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$66.57
|
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Cofinity Commercial |
$76.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.85
|
| Rate for Payer: Healthscope Commercial |
$78.63
|
| Rate for Payer: Healthscope Whirlpool |
$81.06
|
| Rate for Payer: Mclaren Commercial |
$72.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.90
|
| Rate for Payer: Nomi Health Commercial |
$66.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.33
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$81.06
|
|
|
Service Code
|
NDC 70700010916
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$72.95
|
| Rate for Payer: Aetna Medicare |
$29.99
|
| Rate for Payer: ASR ASR |
$78.63
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS Trust/PPO |
$66.83
|
| Rate for Payer: BCN Commercial |
$66.83
|
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Cofinity Commercial |
$76.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.85
|
| Rate for Payer: Healthscope Commercial |
$78.63
|
| Rate for Payer: Healthscope Whirlpool |
$81.06
|
| Rate for Payer: Mclaren Commercial |
$72.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.90
|
| Rate for Payer: Nomi Health Commercial |
$66.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.02
|
| Rate for Payer: Priority Health Narrow Network |
$56.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.33
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
OP
|
$37.01
|
|
|
Service Code
|
NDC 51672125906
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Aetna Commercial |
$33.31
|
| Rate for Payer: Aetna Medicare |
$13.69
|
| Rate for Payer: ASR ASR |
$35.90
|
| Rate for Payer: BCBS Complete |
$14.81
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$30.52
|
| Rate for Payer: Cash Price |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$34.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.61
|
| Rate for Payer: Healthscope Commercial |
$35.90
|
| Rate for Payer: Healthscope Whirlpool |
$37.01
|
| Rate for Payer: Mclaren Commercial |
$33.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.46
|
| Rate for Payer: Nomi Health Commercial |
$30.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.43
|
| Rate for Payer: Priority Health Narrow Network |
$25.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.57
|
|
|
CLOBETASOL 0.05 % TOPICAL OINTMENT
|
Facility
|
IP
|
$37.01
|
|
|
Service Code
|
NDC 51672125906
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Aetna Commercial |
$33.31
|
| Rate for Payer: ASR ASR |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$34.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.61
|
| Rate for Payer: Healthscope Commercial |
$35.90
|
| Rate for Payer: Healthscope Whirlpool |
$37.01
|
| Rate for Payer: Mclaren Commercial |
$33.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.46
|
| Rate for Payer: Nomi Health Commercial |
$30.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.57
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$247.39
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$247.39 |
| Rate for Payer: Aetna Commercial |
$222.65
|
| Rate for Payer: Aetna Medicare |
$91.54
|
| Rate for Payer: ASR ASR |
$239.97
|
| Rate for Payer: BCBS Complete |
$98.96
|
| Rate for Payer: BCBS Trust/PPO |
$203.97
|
| Rate for Payer: BCN Commercial |
$203.97
|
| Rate for Payer: Cash Price |
$197.91
|
| Rate for Payer: Cofinity Commercial |
$232.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.91
|
| Rate for Payer: Healthscope Commercial |
$239.97
|
| Rate for Payer: Healthscope Whirlpool |
$247.39
|
| Rate for Payer: Mclaren Commercial |
$222.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.28
|
| Rate for Payer: Nomi Health Commercial |
$202.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$216.76
|
| Rate for Payer: Priority Health Narrow Network |
$173.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.70
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$247.39
|
|
|
Service Code
|
NDC 49884030702
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.54 |
| Max. Negotiated Rate |
$247.39 |
| Rate for Payer: Aetna Commercial |
$222.65
|
| Rate for Payer: ASR ASR |
$239.97
|
| Rate for Payer: BCBS Trust/PPO |
$203.16
|
| Rate for Payer: BCN Commercial |
$203.16
|
| Rate for Payer: Cash Price |
$197.91
|
| Rate for Payer: Cofinity Commercial |
$232.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.91
|
| Rate for Payer: Healthscope Commercial |
$239.97
|
| Rate for Payer: Healthscope Whirlpool |
$247.39
|
| Rate for Payer: Mclaren Commercial |
$222.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.28
|
| Rate for Payer: Nomi Health Commercial |
$202.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.70
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: ASR ASR |
$4.00
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.61
|
| Rate for Payer: Priority Health Narrow Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 49884030752
|
| Hospital Charge Code |
35626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: ASR ASR |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.51
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 59651072301
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$20.72
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$46.17
|
| Rate for Payer: BCN Commercial |
$46.17
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.00
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: ASR ASR |
$0.93
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$0.93
|
| Rate for Payer: Healthscope Whirlpool |
$0.96
|
| Rate for Payer: Mclaren Commercial |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.82
|
| Rate for Payer: Nomi Health Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.85
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 51079088201
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: ASR ASR |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$0.93
|
| Rate for Payer: Healthscope Whirlpool |
$0.96
|
| Rate for Payer: Mclaren Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.82
|
| Rate for Payer: Nomi Health Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.85
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 59651072301
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$45.99
|
| Rate for Payer: BCN Commercial |
$45.99
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.00
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
CLONAZEPAM 1 MG TABLET
|
Facility
|
OP
|
$52.50
|
|
|
Service Code
|
NDC 43547040710
|
| Hospital Charge Code |
9638
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: ASR ASR |
$50.92
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.29
|
| Rate for Payer: BCN Commercial |
$43.29
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$50.92
|
| Rate for Payer: Healthscope Whirlpool |
$52.50
|
| Rate for Payer: Mclaren Commercial |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: Nomi Health Commercial |
$43.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.00
|
| Rate for Payer: Priority Health Narrow Network |
$36.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.20
|
|
