|
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
|
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
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.58 |
| 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 |
$15.96
|
| Rate for Payer: BCN Commercial |
$15.96
|
| 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 |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$19.44
|
| Rate for Payer: Mclaren Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
NDC 536126511
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: ASR ASR |
$9.07
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Healthscope Whirlpool |
$9.35
|
| Rate for Payer: Mclaren Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: Nomi Health Commercial |
$7.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.23
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
NDC 536126511
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: ASR ASR |
$9.07
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$7.71
|
| Rate for Payer: BCN Commercial |
$7.71
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Healthscope Whirlpool |
$9.35
|
| Rate for Payer: Mclaren Commercial |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: Nomi Health Commercial |
$7.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.20
|
| Rate for Payer: Priority Health Narrow Network |
$6.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.23
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.26
|
|
|
Service Code
|
NDC 536127222
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.44 |
| 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 |
$9.24
|
| Rate for Payer: BCN Commercial |
$9.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Healthscope Whirlpool |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$10.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.57
|
| Rate for Payer: Nomi Health Commercial |
$9.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.91
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 536126595
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Healthscope Whirlpool |
$9.20
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.09
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.21
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$11.21 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: ASR ASR |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.20
|
| Rate for Payer: BCN Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.87
|
| Rate for Payer: Healthscope Whirlpool |
$11.21
|
| Rate for Payer: Mclaren Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Nomi Health Commercial |
$9.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.86
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 536126595
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$7.58
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Healthscope Whirlpool |
$9.20
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.06
|
| Rate for Payer: Priority Health Narrow Network |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.09
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$17.50
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: ASR ASR |
$18.86
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$16.03
|
| 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 |
$18.86
|
| Rate for Payer: Healthscope Whirlpool |
$19.44
|
| Rate for Payer: Mclaren Commercial |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.21
|
|
|
Service Code
|
NDC 51672127502
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$11.21 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$4.15
|
| Rate for Payer: ASR ASR |
$10.87
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.24
|
| Rate for Payer: BCN Commercial |
$9.24
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.87
|
| Rate for Payer: Healthscope Whirlpool |
$11.21
|
| Rate for Payer: Mclaren Commercial |
$10.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Nomi Health Commercial |
$9.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.82
|
| Rate for Payer: Priority Health Narrow Network |
$7.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.86
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.26
|
|
|
Service Code
|
NDC 536127222
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: ASR ASR |
$10.92
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$9.28
|
| Rate for Payer: BCN Commercial |
$9.28
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Healthscope Whirlpool |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$10.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.57
|
| Rate for Payer: Nomi Health Commercial |
$9.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.86
|
| Rate for Payer: Priority Health Narrow Network |
$7.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.91
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$26.15
|
|
|
Service Code
|
NDC 168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: ASR ASR |
$25.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.47
|
| Rate for Payer: BCN Commercial |
$21.47
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$24.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Healthscope Whirlpool |
$26.14
|
| Rate for Payer: Mclaren Commercial |
$23.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.01
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.92
|
|
|
Service Code
|
NDC 472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.69 |
| 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 |
$27.03
|
| Rate for Payer: BCN Commercial |
$27.03
|
| Rate for Payer: Cash Price |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$31.93
|
| Rate for Payer: Healthscope Whirlpool |
$32.92
|
| Rate for Payer: Mclaren Commercial |
$29.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.97
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.63 |
| 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 |
$16.02
|
| Rate for Payer: BCN Commercial |
$16.02
|
| 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 |
$18.92
|
| Rate for Payer: Healthscope Whirlpool |
$19.51
|
| Rate for Payer: Mclaren Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.17
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$26.15
|
|
|
Service Code
|
NDC 168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: ASR ASR |
$25.36
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: Cash Price |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$24.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Healthscope Whirlpool |
$26.14
|
| Rate for Payer: Mclaren Commercial |
$23.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.22
|
| Rate for Payer: Nomi Health Commercial |
$21.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.91
|
| Rate for Payer: Priority Health Narrow Network |
$18.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.01
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna Medicare |
$7.22
|
| Rate for Payer: ASR ASR |
$18.92
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$16.08
|
| 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 |
$18.92
|
| Rate for Payer: Healthscope Whirlpool |
$19.51
|
| Rate for Payer: Mclaren Commercial |
$17.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.09
|
| Rate for Payer: Priority Health Narrow Network |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.17
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.92
|
|
|
Service Code
|
NDC 472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: ASR ASR |
$31.93
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: Cash Price |
$26.33
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$31.93
|
| Rate for Payer: Healthscope Whirlpool |
$32.92
|
| Rate for Payer: Mclaren Commercial |
$29.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.84
|
| Rate for Payer: Priority Health Narrow Network |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.97
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$25,202.30
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$22,785.90 |
| Max. Negotiated Rate |
$25,202.30 |
| Rate for Payer: BCBS Complete |
$25,202.30
|
| Rate for Payer: Mclaren Medicaid |
$24,002.19
|
| Rate for Payer: Meridian Medicaid |
$25,202.30
|
| Rate for Payer: PHP Medicaid |
$22,785.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,002.19
|
| Rate for Payer: UHC Medicaid |
$24,002.19
|
| Rate for Payer: UHCCP Medicaid |
$24,002.19
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$15,397.02
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$13,920.75 |
| Max. Negotiated Rate |
$15,397.02 |
| Rate for Payer: BCBS Complete |
$15,397.02
|
| Rate for Payer: Mclaren Medicaid |
$14,663.83
|
| Rate for Payer: Meridian Medicaid |
$15,397.02
|
| Rate for Payer: PHP Medicaid |
$13,920.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,663.83
|
| Rate for Payer: UHC Medicaid |
$14,663.83
|
| Rate for Payer: UHCCP Medicaid |
$14,663.83
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$4,216.28
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$3,812.02 |
| Max. Negotiated Rate |
$4,216.28 |
| Rate for Payer: BCBS Complete |
$4,216.28
|
| Rate for Payer: Mclaren Medicaid |
$4,015.50
|
| Rate for Payer: Meridian Medicaid |
$4,216.28
|
| Rate for Payer: PHP Medicaid |
$3,812.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,015.50
|
| Rate for Payer: UHC Medicaid |
$4,015.50
|
| Rate for Payer: UHCCP Medicaid |
$4,015.50
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$7,012.42
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$6,340.06 |
| Max. Negotiated Rate |
$7,012.42 |
| Rate for Payer: BCBS Complete |
$7,012.42
|
| Rate for Payer: Mclaren Medicaid |
$6,678.49
|
| Rate for Payer: Meridian Medicaid |
$7,012.42
|
| Rate for Payer: PHP Medicaid |
$6,340.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,678.49
|
| Rate for Payer: UHC Medicaid |
$6,678.49
|
| Rate for Payer: UHCCP Medicaid |
$6,678.49
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$20,955.79
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$12,101.58 |
| Max. Negotiated Rate |
$20,955.79 |
| Rate for Payer: Aetna Medicare |
$12,738.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,923.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,923.14
|
| Rate for Payer: BCBS MAPPO |
$12,738.51
|
| Rate for Payer: BCN Medicare Advantage |
$12,738.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,738.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,738.51
|
| Rate for Payer: Mclaren Medicare |
$12,738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,375.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,649.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,012.36
|
| Rate for Payer: PACE Medicare |
$12,101.58
|
| Rate for Payer: PACE SWMI |
$12,738.51
|
| Rate for Payer: PHP Commercial |
$14,012.36
|
| Rate for Payer: PHP Medicare Advantage |
$12,738.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,955.79
|
| Rate for Payer: Priority Health Medicare |
$12,738.51
|
| Rate for Payer: Priority Health Narrow Network |
$16,764.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12,738.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,738.51
|
| Rate for Payer: UHC Exchange |
$19,744.69
|
| Rate for Payer: UHCCP DNSP |
$12,738.51
|
| Rate for Payer: VA VA |
$12,738.51
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,694.20
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$4,244.12 |
| Max. Negotiated Rate |
$4,694.20 |
| Rate for Payer: BCBS Complete |
$4,694.20
|
| Rate for Payer: Mclaren Medicaid |
$4,470.67
|
| Rate for Payer: Meridian Medicaid |
$4,694.20
|
| Rate for Payer: PHP Medicaid |
$4,244.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,470.67
|
| Rate for Payer: UHC Medicaid |
$4,470.67
|
| Rate for Payer: UHCCP Medicaid |
$4,470.67
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,576.51
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,233.59 |
| Max. Negotiated Rate |
$3,576.51 |
| Rate for Payer: BCBS Complete |
$3,576.51
|
| Rate for Payer: Mclaren Medicaid |
$3,406.20
|
| Rate for Payer: Meridian Medicaid |
$3,576.51
|
| Rate for Payer: PHP Medicaid |
$3,233.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,406.20
|
| Rate for Payer: UHC Medicaid |
$3,406.20
|
| Rate for Payer: UHCCP Medicaid |
$3,406.20
|
|
