|
CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK
|
Facility
|
IP
|
$55.30
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cigna All Commercial |
$47.72
|
| Rate for Payer: CORVEL All Commercial |
$51.43
|
| Rate for Payer: Coventry All Commercial |
$48.66
|
| Rate for Payer: Encore All Commercial |
$50.90
|
| Rate for Payer: Frontpath All Commercial |
$50.88
|
| Rate for Payer: Humana ChoiceCare |
$47.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.77
|
| Rate for Payer: PHCS All Commercial |
$41.48
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Sagamore Health Network All Products |
$42.69
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$48.66
|
| Rate for Payer: United Healthcare Commercial |
$43.58
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV PGBK
|
Facility
|
IP
|
$91.35
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.51 |
| Max. Negotiated Rate |
$84.96 |
| Rate for Payer: Aetna Commercial |
$78.93
|
| Rate for Payer: Cash Price |
$54.81
|
| Rate for Payer: Cigna All Commercial |
$78.84
|
| Rate for Payer: CORVEL All Commercial |
$84.96
|
| Rate for Payer: Coventry All Commercial |
$80.39
|
| Rate for Payer: Encore All Commercial |
$84.09
|
| Rate for Payer: Frontpath All Commercial |
$84.04
|
| Rate for Payer: Humana ChoiceCare |
$78.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.22
|
| Rate for Payer: PHCS All Commercial |
$68.51
|
| Rate for Payer: PHP All Commercial |
$69.28
|
| Rate for Payer: Sagamore Health Network All Products |
$70.52
|
| Rate for Payer: Signature Care EPO |
$75.82
|
| Rate for Payer: Signature Care PPO |
$80.39
|
| Rate for Payer: United Healthcare Commercial |
$71.98
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV PGBK
|
Facility
|
OP
|
$91.35
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$84.96 |
| Rate for Payer: Aetna Commercial |
$77.10
|
| Rate for Payer: Aetna Medicare |
$29.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.16
|
| Rate for Payer: Cash Price |
$54.81
|
| Rate for Payer: Centivo All Commercial |
$49.69
|
| Rate for Payer: Cigna All Commercial |
$78.84
|
| Rate for Payer: CORVEL All Commercial |
$84.96
|
| Rate for Payer: Coventry All Commercial |
$80.39
|
| Rate for Payer: Encore All Commercial |
$84.09
|
| Rate for Payer: Frontpath All Commercial |
$84.04
|
| Rate for Payer: Humana ChoiceCare |
$78.90
|
| Rate for Payer: Humana Medicare |
$29.23
|
| Rate for Payer: Lucent All Commercial |
$49.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.22
|
| Rate for Payer: PHCS All Commercial |
$68.51
|
| Rate for Payer: PHP All Commercial |
$69.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.63
|
| Rate for Payer: Sagamore Health Network All Products |
$70.52
|
| Rate for Payer: Signature Care EPO |
$75.82
|
| Rate for Payer: Signature Care PPO |
$80.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.65
|
| Rate for Payer: United Healthcare Commercial |
$71.98
|
| Rate for Payer: United Healthcare Medicare |
$29.23
|
|
|
CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN
|
Facility
|
OP
|
$19.32
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$17.97 |
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.80
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Centivo All Commercial |
$10.51
|
| Rate for Payer: Cigna All Commercial |
$16.67
|
| Rate for Payer: CORVEL All Commercial |
$17.97
|
| Rate for Payer: Coventry All Commercial |
$17.00
|
| Rate for Payer: Encore All Commercial |
$17.78
|
| Rate for Payer: Frontpath All Commercial |
$17.77
|
| Rate for Payer: Humana ChoiceCare |
$16.69
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Lucent All Commercial |
$10.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.39
|
| Rate for Payer: PHCS All Commercial |
$14.49
|
| Rate for Payer: PHP All Commercial |
$14.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.53
|
| Rate for Payer: Sagamore Health Network All Products |
$14.92
|
| Rate for Payer: Signature Care EPO |
$16.04
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.42
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$6.18
|
|
|
CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN
|
Facility
|
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$17.97 |
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Cigna All Commercial |
$16.67
|
| Rate for Payer: CORVEL All Commercial |
$17.97
|
| Rate for Payer: Coventry All Commercial |
$17.00
|
| Rate for Payer: Encore All Commercial |
$17.78
|
| Rate for Payer: Frontpath All Commercial |
$17.77
|
| Rate for Payer: Humana ChoiceCare |
$16.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.39
|
| Rate for Payer: PHCS All Commercial |
$14.49
|
| Rate for Payer: PHP All Commercial |
$14.65
|
| Rate for Payer: Sagamore Health Network All Products |
$14.92
|
| Rate for Payer: Signature Care EPO |
$16.04
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
|
|
CLOBAZAM 10 MG ORAL TAB
|
Facility
|
OP
|
$20.34
|
|
|
Service Code
|
NDC 60687042321
|
| Hospital Charge Code |
153643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna Commercial |
$17.17
|
| Rate for Payer: Aetna Medicare |
$6.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.16
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Centivo All Commercial |
$11.07
|
| Rate for Payer: Cigna All Commercial |
$17.56
|
| Rate for Payer: CORVEL All Commercial |
$18.92
|
| Rate for Payer: Coventry All Commercial |
$17.90
|
| Rate for Payer: Encore All Commercial |
$18.72
|
| Rate for Payer: Frontpath All Commercial |
$18.71
|
| Rate for Payer: Humana ChoiceCare |
$17.57
|
| Rate for Payer: Humana Medicare |
$6.51
|
| Rate for Payer: Lucent All Commercial |
$11.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.31
|
| Rate for Payer: PHCS All Commercial |
$15.26
|
| Rate for Payer: PHP All Commercial |
$15.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.93
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Signature Care EPO |
$16.88
|
| Rate for Payer: Signature Care PPO |
$17.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.29
|
| Rate for Payer: United Healthcare Commercial |
$16.03
|
| Rate for Payer: United Healthcare Medicare |
$6.51
|
|
|
CLOBAZAM 10 MG ORAL TAB
|
Facility
|
IP
|
$20.34
|
|
|
Service Code
|
NDC 60687042321
|
| Hospital Charge Code |
153643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna Commercial |
$17.58
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna All Commercial |
$17.56
|
| Rate for Payer: CORVEL All Commercial |
$18.92
|
| Rate for Payer: Coventry All Commercial |
$17.90
|
| Rate for Payer: Encore All Commercial |
$18.72
|
| Rate for Payer: Frontpath All Commercial |
$18.71
|
| Rate for Payer: Humana ChoiceCare |
$17.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.31
|
| Rate for Payer: PHCS All Commercial |
$15.26
|
| Rate for Payer: PHP All Commercial |
$15.43
|
| Rate for Payer: Sagamore Health Network All Products |
$15.70
|
| Rate for Payer: Signature Care EPO |
$16.88
|
| Rate for Payer: Signature Care PPO |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$16.03
|
|
|
CLOBETASOL 0.05 % TOP CREA
|
Facility
|
IP
|
$32.66
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna Commercial |
$28.21
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cigna All Commercial |
$28.18
|
| Rate for Payer: CORVEL All Commercial |
$30.37
|
| Rate for Payer: Coventry All Commercial |
$28.74
|
| Rate for Payer: Encore All Commercial |
$30.06
|
| Rate for Payer: Frontpath All Commercial |
$30.04
|
| Rate for Payer: Humana ChoiceCare |
$28.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.39
|
| Rate for Payer: PHCS All Commercial |
$24.49
|
| Rate for Payer: PHP All Commercial |
$24.77
|
| Rate for Payer: Sagamore Health Network All Products |
$25.21
|
| Rate for Payer: Signature Care EPO |
$27.10
|
| Rate for Payer: Signature Care PPO |
$28.74
|
| Rate for Payer: United Healthcare Commercial |
$25.73
|
|
|
CLOBETASOL 0.05 % TOP CREA
|
Facility
|
OP
|
$32.66
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| Rate for Payer: Aetna Medicare |
$10.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.49
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Centivo All Commercial |
$17.76
|
| Rate for Payer: Cigna All Commercial |
$28.18
|
| Rate for Payer: CORVEL All Commercial |
$30.37
|
| Rate for Payer: Coventry All Commercial |
$28.74
|
| Rate for Payer: Encore All Commercial |
$30.06
|
| Rate for Payer: Frontpath All Commercial |
$30.04
|
| Rate for Payer: Humana ChoiceCare |
$28.20
|
| Rate for Payer: Humana Medicare |
$10.45
|
| Rate for Payer: Lucent All Commercial |
$17.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.39
|
| Rate for Payer: PHCS All Commercial |
$24.49
|
| Rate for Payer: PHP All Commercial |
$24.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.74
|
| Rate for Payer: Sagamore Health Network All Products |
$25.21
|
| Rate for Payer: Signature Care EPO |
$27.10
|
| Rate for Payer: Signature Care PPO |
$28.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.76
|
| Rate for Payer: United Healthcare Commercial |
$25.73
|
| Rate for Payer: United Healthcare Medicare |
$10.45
|
|
|
CLOBETASOL 0.05 % TOP OINT
|
Facility
|
OP
|
$23.84
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$22.17 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.39
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Centivo All Commercial |
$12.97
|
| Rate for Payer: Cigna All Commercial |
$20.57
|
| Rate for Payer: CORVEL All Commercial |
$22.17
|
| Rate for Payer: Coventry All Commercial |
$20.97
|
| Rate for Payer: Encore All Commercial |
$21.94
|
| Rate for Payer: Frontpath All Commercial |
$21.93
|
| Rate for Payer: Humana ChoiceCare |
$20.59
|
| Rate for Payer: Humana Medicare |
$7.63
|
| Rate for Payer: Lucent All Commercial |
$12.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.45
|
| Rate for Payer: PHCS All Commercial |
$17.88
|
| Rate for Payer: PHP All Commercial |
$18.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.30
|
| Rate for Payer: Sagamore Health Network All Products |
$18.40
|
| Rate for Payer: Signature Care EPO |
$19.78
|
| Rate for Payer: Signature Care PPO |
$20.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.26
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
| Rate for Payer: United Healthcare Medicare |
$7.63
|
|
|
CLOBETASOL 0.05 % TOP OINT
|
Facility
|
IP
|
$23.84
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$22.17 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cigna All Commercial |
$20.57
|
| Rate for Payer: CORVEL All Commercial |
$22.17
|
| Rate for Payer: Coventry All Commercial |
$20.97
|
| Rate for Payer: Encore All Commercial |
$21.94
|
| Rate for Payer: Frontpath All Commercial |
$21.93
|
| Rate for Payer: Humana ChoiceCare |
$20.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.45
|
| Rate for Payer: PHCS All Commercial |
$17.88
|
| Rate for Payer: PHP All Commercial |
$18.08
|
| Rate for Payer: Sagamore Health Network All Products |
$18.40
|
| Rate for Payer: Signature Care EPO |
$19.78
|
| Rate for Payer: Signature Care PPO |
$20.97
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
|
|
CLONAZEPAM 0.5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
CLONAZEPAM 0.5 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
CLONAZEPAM 0.5 MG ORAL TBDL
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 49884030802
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
CLONAZEPAM 0.5 MG ORAL TBDL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 49884030852
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
CLONAZEPAM 0.5 MG ORAL TBDL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 49884030802
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
CLONAZEPAM 0.5 MG ORAL TBDL
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 49884030852
|
| Hospital Charge Code |
35627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
CLONIDINE 0.1 MG/24 HR TD PTWK
|
Facility
|
OP
|
$231.84
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Aetna Commercial |
$195.67
|
| Rate for Payer: Aetna Medicare |
$74.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$133.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.61
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Centivo All Commercial |
$126.12
|
| Rate for Payer: Cigna All Commercial |
$200.08
|
| Rate for Payer: CORVEL All Commercial |
$215.61
|
| Rate for Payer: Coventry All Commercial |
$204.02
|
| Rate for Payer: Encore All Commercial |
$213.41
|
| Rate for Payer: Frontpath All Commercial |
$213.29
|
| Rate for Payer: Humana ChoiceCare |
$200.24
|
| Rate for Payer: Humana Medicare |
$74.19
|
| Rate for Payer: Lucent All Commercial |
$126.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.66
|
| Rate for Payer: PHCS All Commercial |
$173.88
|
| Rate for Payer: PHP All Commercial |
$175.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.42
|
| Rate for Payer: Sagamore Health Network All Products |
$178.98
|
| Rate for Payer: Signature Care EPO |
$192.43
|
| Rate for Payer: Signature Care PPO |
$204.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.06
|
| Rate for Payer: United Healthcare Commercial |
$182.69
|
| Rate for Payer: United Healthcare Medicare |
$74.19
|
|
|
CLONIDINE 0.1 MG/24 HR TD PTWK
|
Facility
|
IP
|
$231.84
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Aetna Commercial |
$200.31
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cigna All Commercial |
$200.08
|
| Rate for Payer: CORVEL All Commercial |
$215.61
|
| Rate for Payer: Coventry All Commercial |
$204.02
|
| Rate for Payer: Encore All Commercial |
$213.41
|
| Rate for Payer: Frontpath All Commercial |
$213.29
|
| Rate for Payer: Humana ChoiceCare |
$200.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.66
|
| Rate for Payer: PHCS All Commercial |
$173.88
|
| Rate for Payer: PHP All Commercial |
$175.83
|
| Rate for Payer: Sagamore Health Network All Products |
$178.98
|
| Rate for Payer: Signature Care EPO |
$192.43
|
| Rate for Payer: Signature Care PPO |
$204.02
|
| Rate for Payer: United Healthcare Commercial |
$182.69
|
|
|
CLONIDINE HCL 0.1 MG ORAL TAB
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Centivo All Commercial |
$1.13
|
| Rate for Payer: Cigna All Commercial |
$1.79
|
| Rate for Payer: CORVEL All Commercial |
$1.93
|
| Rate for Payer: Coventry All Commercial |
$1.83
|
| Rate for Payer: Encore All Commercial |
$1.91
|
| Rate for Payer: Frontpath All Commercial |
$1.91
|
| Rate for Payer: Humana ChoiceCare |
$1.80
|
| Rate for Payer: Humana Medicare |
$0.67
|
| Rate for Payer: Lucent All Commercial |
$1.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.87
|
| Rate for Payer: PHCS All Commercial |
$1.56
|
| Rate for Payer: PHP All Commercial |
$1.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1.60
|
| Rate for Payer: Signature Care EPO |
$1.73
|
| Rate for Payer: Signature Care PPO |
$1.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.77
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
|
|
CLONIDINE HCL 0.1 MG ORAL TAB
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna All Commercial |
$1.79
|
| Rate for Payer: CORVEL All Commercial |
$1.93
|
| Rate for Payer: Coventry All Commercial |
$1.83
|
| Rate for Payer: Encore All Commercial |
$1.91
|
| Rate for Payer: Frontpath All Commercial |
$1.91
|
| Rate for Payer: Humana ChoiceCare |
$1.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.87
|
| Rate for Payer: PHCS All Commercial |
$1.56
|
| Rate for Payer: PHP All Commercial |
$1.58
|
| Rate for Payer: Sagamore Health Network All Products |
$1.60
|
| Rate for Payer: Signature Care EPO |
$1.73
|
| Rate for Payer: Signature Care PPO |
$1.83
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPID SOLN
|
Facility
|
OP
|
$205.66
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$191.26 |
| Rate for Payer: Aetna Commercial |
$173.58
|
| Rate for Payer: Aetna Medicare |
$65.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.39
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Centivo All Commercial |
$111.88
|
| Rate for Payer: Cigna All Commercial |
$177.48
|
| Rate for Payer: CORVEL All Commercial |
$191.26
|
| Rate for Payer: Coventry All Commercial |
$180.98
|
| Rate for Payer: Encore All Commercial |
$189.31
|
| Rate for Payer: Frontpath All Commercial |
$189.21
|
| Rate for Payer: Humana ChoiceCare |
$177.63
|
| Rate for Payer: Humana Medicare |
$65.81
|
| Rate for Payer: Lucent All Commercial |
$111.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.09
|
| Rate for Payer: PHCS All Commercial |
$154.25
|
| Rate for Payer: PHP All Commercial |
$155.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.21
|
| Rate for Payer: Sagamore Health Network All Products |
$158.77
|
| Rate for Payer: Signature Care EPO |
$170.70
|
| Rate for Payer: Signature Care PPO |
$180.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.81
|
| Rate for Payer: United Healthcare Commercial |
$162.06
|
| Rate for Payer: United Healthcare Medicare |
$65.81
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPID SOLN
|
Facility
|
IP
|
$205.66
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$191.26 |
| Rate for Payer: Aetna Commercial |
$177.69
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cigna All Commercial |
$177.48
|
| Rate for Payer: CORVEL All Commercial |
$191.26
|
| Rate for Payer: Coventry All Commercial |
$180.98
|
| Rate for Payer: Encore All Commercial |
$189.31
|
| Rate for Payer: Frontpath All Commercial |
$189.21
|
| Rate for Payer: Humana ChoiceCare |
$177.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.09
|
| Rate for Payer: PHCS All Commercial |
$154.25
|
| Rate for Payer: PHP All Commercial |
$155.97
|
| Rate for Payer: Sagamore Health Network All Products |
$158.77
|
| Rate for Payer: Signature Care EPO |
$170.70
|
| Rate for Payer: Signature Care PPO |
$180.98
|
| Rate for Payer: United Healthcare Commercial |
$162.06
|
|
|
CLOPIDOGREL 75 MG ORAL TAB
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 68084053611
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.29
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Centivo All Commercial |
$0.83
|
| Rate for Payer: Cigna All Commercial |
$1.32
|
| Rate for Payer: CORVEL All Commercial |
$1.43
|
| Rate for Payer: Coventry All Commercial |
$1.35
|
| Rate for Payer: Encore All Commercial |
$1.41
|
| Rate for Payer: Frontpath All Commercial |
$1.41
|
| Rate for Payer: Humana ChoiceCare |
$1.32
|
| Rate for Payer: Humana Medicare |
$0.49
|
| Rate for Payer: Lucent All Commercial |
$0.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.38
|
| Rate for Payer: PHCS All Commercial |
$1.15
|
| Rate for Payer: PHP All Commercial |
$1.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1.18
|
| Rate for Payer: Signature Care EPO |
$1.27
|
| Rate for Payer: Signature Care PPO |
$1.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
|
|
CLOPIDOGREL 75 MG ORAL TAB
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.29
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Centivo All Commercial |
$0.83
|
| Rate for Payer: Cigna All Commercial |
$1.32
|
| Rate for Payer: CORVEL All Commercial |
$1.43
|
| Rate for Payer: Coventry All Commercial |
$1.35
|
| Rate for Payer: Encore All Commercial |
$1.41
|
| Rate for Payer: Frontpath All Commercial |
$1.41
|
| Rate for Payer: Humana ChoiceCare |
$1.32
|
| Rate for Payer: Humana Medicare |
$0.49
|
| Rate for Payer: Lucent All Commercial |
$0.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.38
|
| Rate for Payer: PHCS All Commercial |
$1.15
|
| Rate for Payer: PHP All Commercial |
$1.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1.18
|
| Rate for Payer: Signature Care EPO |
$1.27
|
| Rate for Payer: Signature Care PPO |
$1.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
|
