|
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
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$91.18
|
|
|
Service Code
|
NDC 378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.39 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna Commercial |
$82.06
|
| Rate for Payer: ASR ASR |
$88.44
|
| Rate for Payer: BCBS Trust/PPO |
$74.88
|
| Rate for Payer: BCN Commercial |
$74.88
|
| 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 |
$88.44
|
| Rate for Payer: Healthscope Whirlpool |
$91.18
|
| 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: Opus (Opus Packaging Group) HMA |
$68.39
|
| 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 378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.54 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$328.25
|
| Rate for Payer: ASR ASR |
$353.78
|
| Rate for Payer: BCBS Trust/PPO |
$299.51
|
| Rate for Payer: BCN Commercial |
$299.51
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cofinity Commercial |
$342.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.77
|
| Rate for Payer: Healthscope Commercial |
$353.78
|
| Rate for Payer: Healthscope Whirlpool |
$364.72
|
| 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: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.95
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
NDC 75907002311
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna Commercial |
$27.60
|
| Rate for Payer: ASR ASR |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$25.18
|
| Rate for Payer: BCN Commercial |
$25.18
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$28.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$29.75
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Nomi Health Commercial |
$25.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.99
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$364.72
|
|
|
Service Code
|
NDC 378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$328.25
|
| Rate for Payer: Aetna Medicare |
$134.95
|
| Rate for Payer: ASR ASR |
$353.78
|
| Rate for Payer: BCBS Complete |
$145.89
|
| Rate for Payer: BCBS Trust/PPO |
$300.71
|
| Rate for Payer: BCN Commercial |
$300.71
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cofinity Commercial |
$342.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.77
|
| Rate for Payer: Healthscope Commercial |
$353.78
|
| Rate for Payer: Healthscope Whirlpool |
$364.72
|
| Rate for Payer: Mclaren Commercial |
$328.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.01
|
| Rate for Payer: Nomi Health Commercial |
$299.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.54
|
| Rate for Payer: Priority Health Cigna 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
|
$122.66
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$122.66 |
| Rate for Payer: Aetna Commercial |
$110.40
|
| Rate for Payer: ASR ASR |
$118.98
|
| Rate for Payer: BCBS Trust/PPO |
$100.73
|
| Rate for Payer: BCN Commercial |
$100.73
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$115.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.13
|
| Rate for Payer: Healthscope Commercial |
$118.98
|
| Rate for Payer: Healthscope Whirlpool |
$122.66
|
| Rate for Payer: Mclaren Commercial |
$110.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.26
|
| Rate for Payer: Nomi Health Commercial |
$100.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.94
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
NDC 75907002311
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna Commercial |
$27.60
|
| Rate for Payer: Aetna Medicare |
$11.35
|
| Rate for Payer: ASR ASR |
$29.75
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.28
|
| Rate for Payer: BCN Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$28.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$29.75
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$27.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.07
|
| Rate for Payer: Nomi Health Commercial |
$25.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.87
|
| Rate for Payer: Priority Health Narrow Network |
$21.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.99
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$91.18
|
|
|
Service Code
|
NDC 378087116
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna Commercial |
$82.06
|
| Rate for Payer: Aetna Medicare |
$33.74
|
| Rate for Payer: ASR ASR |
$88.44
|
| Rate for Payer: BCBS Complete |
$36.47
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$75.18
|
| 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 |
$88.44
|
| Rate for Payer: Healthscope Whirlpool |
$91.18
|
| Rate for Payer: Mclaren Commercial |
$82.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$74.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.39
|
| Rate for Payer: Priority Health Cigna 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
|
OP
|
$122.66
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$122.66 |
| Rate for Payer: Aetna Commercial |
$110.40
|
| Rate for Payer: Aetna Medicare |
$45.39
|
| Rate for Payer: ASR ASR |
$118.98
|
| Rate for Payer: BCBS Complete |
$49.07
|
| Rate for Payer: BCBS Trust/PPO |
$101.14
|
| Rate for Payer: BCN Commercial |
$101.14
|
| Rate for Payer: Cash Price |
$98.13
|
| Rate for Payer: Cofinity Commercial |
$115.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.13
|
| Rate for Payer: Healthscope Commercial |
$118.98
|
| Rate for Payer: Healthscope Whirlpool |
$122.66
|
| Rate for Payer: Mclaren Commercial |
$110.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.26
|
| Rate for Payer: Nomi Health Commercial |
$100.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.48
|
| Rate for Payer: Priority Health Narrow Network |
$85.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.94
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$31.30
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: BCBS Trust/PPO |
$69.75
|
| Rate for Payer: BCN Commercial |
$69.75
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Healthscope Whirlpool |
$84.60
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.13
|
| Rate for Payer: Priority Health Narrow Network |
$59.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: ASR ASR |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Healthscope Whirlpool |
$2.88
|
| Rate for Payer: Mclaren Commercial |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.52
|
| Rate for Payer: Priority Health Narrow Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.53
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.89 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$259.06
|
| Rate for Payer: ASR ASR |
$279.21
|
| Rate for Payer: BCBS Trust/PPO |
$236.38
|
| Rate for Payer: BCN Commercial |
$236.38
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$270.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$279.21
|
| Rate for Payer: Healthscope Whirlpool |
$287.85
|
| Rate for Payer: Mclaren Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.31
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare |
$97.01
|
| Rate for Payer: ASR ASR |
$254.33
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: BCBS Trust/PPO |
$216.18
|
| Rate for Payer: BCN Commercial |
$216.18
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$246.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$254.33
|
| Rate for Payer: Healthscope Whirlpool |
$262.20
|
| Rate for Payer: Mclaren Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.74
|
| Rate for Payer: Priority Health Narrow Network |
$183.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.74
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 60687011311
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: ASR ASR |
$2.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Healthscope Whirlpool |
$2.88
|
| Rate for Payer: Mclaren Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.53
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
OP
|
$287.85
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$259.06
|
| Rate for Payer: Aetna Medicare |
$106.50
|
| Rate for Payer: ASR ASR |
$279.21
|
| Rate for Payer: BCBS Complete |
$115.14
|
| Rate for Payer: BCBS Trust/PPO |
$237.33
|
| Rate for Payer: BCN Commercial |
$237.33
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$270.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$279.21
|
| Rate for Payer: Healthscope Whirlpool |
$287.85
|
| Rate for Payer: Mclaren Commercial |
$259.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.67
|
| Rate for Payer: Nomi Health Commercial |
$236.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$252.21
|
| Rate for Payer: Priority Health Narrow Network |
$201.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.31
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 228212710
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: BCBS Trust/PPO |
$69.47
|
| Rate for Payer: BCN Commercial |
$69.47
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Healthscope Whirlpool |
$84.60
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
CLONIDINE HCL 0.1 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 904744261
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: ASR ASR |
$254.33
|
| Rate for Payer: BCBS Trust/PPO |
$215.32
|
| Rate for Payer: BCN Commercial |
$215.32
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Commercial |
$246.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$254.33
|
| Rate for Payer: Healthscope Whirlpool |
$262.20
|
| Rate for Payer: Mclaren Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.74
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION
|
Facility
|
IP
|
$232.58
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$232.58 |
| Rate for Payer: Aetna Commercial |
$209.32
|
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: ASR ASR |
$225.60
|
| Rate for Payer: ASR ASR |
$156.82
|
| Rate for Payer: ASR ASR |
$140.65
|
| Rate for Payer: BCBS Trust/PPO |
$190.99
|
| Rate for Payer: BCBS Trust/PPO |
$119.07
|
| Rate for Payer: BCBS Trust/PPO |
$132.77
|
| Rate for Payer: BCBS Trust/PPO |
$222.55
|
| Rate for Payer: BCN Commercial |
$119.07
|
| Rate for Payer: BCN Commercial |
$222.55
|
| Rate for Payer: BCN Commercial |
$132.77
|
| Rate for Payer: BCN Commercial |
$190.99
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Cofinity Commercial |
$136.30
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Cofinity Commercial |
$151.97
|
| 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 |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$140.65
|
| Rate for Payer: Healthscope Commercial |
$156.82
|
| Rate for Payer: Healthscope Commercial |
$262.87
|
| Rate for Payer: Healthscope Whirlpool |
$232.58
|
| Rate for Payer: Healthscope Whirlpool |
$271.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.68
|
| Rate for Payer: Mclaren Commercial |
$130.50
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Commercial |
$209.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$132.57
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Nomi Health Commercial |
$190.72
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION
|
Facility
|
OP
|
$271.01
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Aetna Commercial |
$209.32
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$53.65
|
| Rate for Payer: Aetna Medicare |
$100.27
|
| Rate for Payer: Aetna Medicare |
$86.05
|
| Rate for Payer: Aetna Medicare |
$59.82
|
| Rate for Payer: ASR ASR |
$225.60
|
| Rate for Payer: ASR ASR |
$156.82
|
| Rate for Payer: ASR ASR |
$140.65
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: BCBS Complete |
$93.03
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS Complete |
$64.67
|
| Rate for Payer: BCBS Trust/PPO |
$133.30
|
| Rate for Payer: BCBS Trust/PPO |
$223.44
|
| Rate for Payer: BCBS Trust/PPO |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$119.55
|
| Rate for Payer: BCN Commercial |
$223.44
|
| Rate for Payer: BCN Commercial |
$191.76
|
| Rate for Payer: BCN Commercial |
$119.55
|
| Rate for Payer: BCN Commercial |
$133.30
|
| Rate for Payer: Cash Price |
$116.00
|
| 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 |
$129.34
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$186.06
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Cofinity Commercial |
$136.30
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Cofinity Commercial |
$151.97
|
| 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 |
$116.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.06
|
| Rate for Payer: Healthscope Commercial |
$262.87
|
| Rate for Payer: Healthscope Commercial |
$140.65
|
| Rate for Payer: Healthscope Commercial |
$156.82
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$145.00
|
| Rate for Payer: Healthscope Whirlpool |
$232.58
|
| Rate for Payer: Healthscope Whirlpool |
$271.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.68
|
| Rate for Payer: Mclaren Commercial |
$209.32
|
| Rate for Payer: Mclaren Commercial |
$145.51
|
| Rate for Payer: Mclaren Commercial |
$130.50
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: Nomi Health Commercial |
$190.72
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Nomi Health Commercial |
$132.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| 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 |
$127.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.27
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.52
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.28
|
| Rate for Payer: Priority Health Narrow Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$124.79
|
|
|
Service Code
|
NDC 55111019690
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$112.31
|
| Rate for Payer: ASR ASR |
$121.04
|
| Rate for Payer: BCBS Trust/PPO |
$102.47
|
| Rate for Payer: BCN Commercial |
$102.47
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$117.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$121.04
|
| Rate for Payer: Healthscope Whirlpool |
$124.78
|
| Rate for Payer: Mclaren Commercial |
$112.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.81
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$149.55
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$333.26
|
| Rate for Payer: BCN Commercial |
$333.26
|
| 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 |
$392.07
|
| Rate for Payer: Healthscope Whirlpool |
$404.20
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Priority Health Cigna 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
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$234.27
|
| Rate for Payer: Aetna Medicare |
$96.31
|
| Rate for Payer: ASR ASR |
$252.49
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: BCBS Trust/PPO |
$214.62
|
| Rate for Payer: BCN Commercial |
$214.62
|
| 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 |
$252.49
|
| Rate for Payer: Healthscope Whirlpool |
$260.30
|
| Rate for Payer: Mclaren Commercial |
$234.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Nomi Health Commercial |
$213.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: Priority Health Cigna 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
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.15 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$331.93
|
| Rate for Payer: BCN Commercial |
$331.93
|
| 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 |
$392.07
|
| Rate for Payer: Healthscope Whirlpool |
$404.20
|
| 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: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
CLOPIDOGREL 75 MG TABLET
|
Facility
|
OP
|
$124.79
|
|
|
Service Code
|
NDC 55111019690
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$112.31
|
| Rate for Payer: Aetna Medicare |
$46.17
|
| Rate for Payer: ASR ASR |
$121.04
|
| Rate for Payer: BCBS Complete |
$49.91
|
| Rate for Payer: BCBS Trust/PPO |
$102.89
|
| Rate for Payer: BCN Commercial |
$102.89
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$117.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$121.04
|
| Rate for Payer: Healthscope Whirlpool |
$124.78
|
| Rate for Payer: Mclaren Commercial |
$112.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.34
|
| Rate for Payer: Priority Health Narrow Network |
$87.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.81
|
|
