|
CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$45.79
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.69
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Centivo All Commercial |
$27.67
|
| Rate for Payer: Cigna All Commercial |
$46.82
|
| Rate for Payer: CORVEL All Commercial |
$50.45
|
| Rate for Payer: Coventry All Commercial |
$47.74
|
| Rate for Payer: Encore All Commercial |
$49.94
|
| Rate for Payer: Frontpath All Commercial |
$49.91
|
| Rate for Payer: Humana ChoiceCare |
$46.86
|
| Rate for Payer: Humana Medicare |
$27.67
|
| Rate for Payer: Lucent All Commercial |
$27.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.82
|
| Rate for Payer: PHCS All Commercial |
$40.69
|
| Rate for Payer: PHP All Commercial |
$41.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.16
|
| Rate for Payer: Sagamore Health Network All Products |
$41.88
|
| Rate for Payer: Signature Care EPO |
$45.03
|
| Rate for Payer: Signature Care PPO |
$47.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.11
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$17.90
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV PGBK
|
Facility
|
OP
|
$64.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Aetna Medicare |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.25
|
| Rate for Payer: Cash Price |
$39.71
|
| Rate for Payer: Centivo All Commercial |
$32.67
|
| Rate for Payer: Cigna All Commercial |
$55.28
|
| Rate for Payer: CORVEL All Commercial |
$59.57
|
| Rate for Payer: Coventry All Commercial |
$56.36
|
| Rate for Payer: Encore All Commercial |
$58.96
|
| Rate for Payer: Frontpath All Commercial |
$58.93
|
| Rate for Payer: Humana ChoiceCare |
$55.32
|
| Rate for Payer: Humana Medicare |
$32.67
|
| Rate for Payer: Lucent All Commercial |
$32.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.64
|
| Rate for Payer: PHCS All Commercial |
$48.04
|
| Rate for Payer: PHP All Commercial |
$48.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.98
|
| Rate for Payer: Sagamore Health Network All Products |
$49.45
|
| Rate for Payer: Signature Care EPO |
$53.16
|
| Rate for Payer: Signature Care PPO |
$56.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.44
|
| Rate for Payer: United Healthcare Commercial |
$50.47
|
| Rate for Payer: United Healthcare Medicare |
$21.14
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV PGBK
|
Facility
|
IP
|
$64.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$59.57 |
| Rate for Payer: Aetna Commercial |
$55.34
|
| Rate for Payer: Cash Price |
$39.71
|
| Rate for Payer: Cigna All Commercial |
$55.28
|
| Rate for Payer: CORVEL All Commercial |
$59.57
|
| Rate for Payer: Coventry All Commercial |
$56.36
|
| Rate for Payer: Encore All Commercial |
$58.96
|
| Rate for Payer: Frontpath All Commercial |
$58.93
|
| Rate for Payer: Humana ChoiceCare |
$55.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.64
|
| Rate for Payer: PHCS All Commercial |
$48.04
|
| Rate for Payer: PHP All Commercial |
$48.58
|
| Rate for Payer: Sagamore Health Network All Products |
$49.45
|
| Rate for Payer: Signature Care EPO |
$53.16
|
| Rate for Payer: Signature Care PPO |
$56.36
|
| Rate for Payer: United Healthcare Commercial |
$50.47
|
|
|
CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.10
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Centivo All Commercial |
$9.98
|
| Rate for Payer: Cigna All Commercial |
$16.89
|
| Rate for Payer: CORVEL All Commercial |
$18.20
|
| Rate for Payer: Coventry All Commercial |
$17.22
|
| Rate for Payer: Encore All Commercial |
$18.02
|
| Rate for Payer: Frontpath All Commercial |
$18.01
|
| Rate for Payer: Humana ChoiceCare |
$16.90
|
| Rate for Payer: Humana Medicare |
$9.98
|
| Rate for Payer: Lucent All Commercial |
$9.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.61
|
| Rate for Payer: PHCS All Commercial |
$14.68
|
| Rate for Payer: PHP All Commercial |
$14.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.63
|
| Rate for Payer: Sagamore Health Network All Products |
$15.11
|
| Rate for Payer: Signature Care EPO |
$16.24
|
| Rate for Payer: Signature Care PPO |
$17.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.64
|
| Rate for Payer: United Healthcare Commercial |
$15.42
|
| Rate for Payer: United Healthcare Medicare |
$6.46
|
|
|
CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
1743
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Cigna All Commercial |
$16.89
|
| Rate for Payer: CORVEL All Commercial |
$18.20
|
| Rate for Payer: Coventry All Commercial |
$17.22
|
| Rate for Payer: Encore All Commercial |
$18.02
|
| Rate for Payer: Frontpath All Commercial |
$18.01
|
| Rate for Payer: Humana ChoiceCare |
$16.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.61
|
| Rate for Payer: PHCS All Commercial |
$14.68
|
| Rate for Payer: PHP All Commercial |
$14.84
|
| Rate for Payer: Sagamore Health Network All Products |
$15.11
|
| Rate for Payer: Signature Care EPO |
$16.24
|
| Rate for Payer: Signature Care PPO |
$17.22
|
| Rate for Payer: United Healthcare Commercial |
$15.42
|
|
|
CLOBAZAM 10 MG ORAL TAB
|
Facility
|
IP
|
$17.13
|
|
|
Service Code
|
NDC 60687042321
|
| Hospital Charge Code |
153643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Aetna Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna All Commercial |
$14.78
|
| Rate for Payer: CORVEL All Commercial |
$15.93
|
| Rate for Payer: Coventry All Commercial |
$15.07
|
| Rate for Payer: Encore All Commercial |
$15.77
|
| Rate for Payer: Frontpath All Commercial |
$15.76
|
| Rate for Payer: Humana ChoiceCare |
$14.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.42
|
| Rate for Payer: PHCS All Commercial |
$12.85
|
| Rate for Payer: PHP All Commercial |
$12.99
|
| Rate for Payer: Sagamore Health Network All Products |
$13.22
|
| Rate for Payer: Signature Care EPO |
$14.22
|
| Rate for Payer: Signature Care PPO |
$15.07
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
|
|
CLOBAZAM 10 MG ORAL TAB
|
Facility
|
OP
|
$17.13
|
|
|
Service Code
|
NDC 60687042321
|
| Hospital Charge Code |
153643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Aetna Commercial |
$14.46
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.22
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Centivo All Commercial |
$8.74
|
| Rate for Payer: Cigna All Commercial |
$14.78
|
| Rate for Payer: CORVEL All Commercial |
$15.93
|
| Rate for Payer: Coventry All Commercial |
$15.07
|
| Rate for Payer: Encore All Commercial |
$15.77
|
| Rate for Payer: Frontpath All Commercial |
$15.76
|
| Rate for Payer: Humana ChoiceCare |
$14.79
|
| Rate for Payer: Humana Medicare |
$8.74
|
| Rate for Payer: Lucent All Commercial |
$8.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.42
|
| Rate for Payer: PHCS All Commercial |
$12.85
|
| Rate for Payer: PHP All Commercial |
$12.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.68
|
| Rate for Payer: Sagamore Health Network All Products |
$13.22
|
| Rate for Payer: Signature Care EPO |
$14.22
|
| Rate for Payer: Signature Care PPO |
$15.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.56
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
| Rate for Payer: United Healthcare Medicare |
$5.65
|
|
|
CLOBETASOL 0.05 % SCLP SOLN
|
Facility
|
OP
|
$121.28
|
|
|
Service Code
|
NDC 68462053228
|
| Hospital Charge Code |
9632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.02 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Aetna Commercial |
$102.36
|
| Rate for Payer: Aetna Medicare |
$40.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$69.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$75.19
|
| Rate for Payer: Centivo All Commercial |
$61.85
|
| Rate for Payer: Cigna All Commercial |
$104.66
|
| Rate for Payer: CORVEL All Commercial |
$112.79
|
| Rate for Payer: Coventry All Commercial |
$106.72
|
| Rate for Payer: Encore All Commercial |
$111.63
|
| Rate for Payer: Frontpath All Commercial |
$111.57
|
| Rate for Payer: Humana ChoiceCare |
$104.75
|
| Rate for Payer: Humana Medicare |
$61.85
|
| Rate for Payer: Lucent All Commercial |
$61.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.15
|
| Rate for Payer: PHCS All Commercial |
$90.96
|
| Rate for Payer: PHP All Commercial |
$91.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.30
|
| Rate for Payer: Sagamore Health Network All Products |
$93.62
|
| Rate for Payer: Signature Care EPO |
$100.66
|
| Rate for Payer: Signature Care PPO |
$106.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.08
|
| Rate for Payer: United Healthcare Commercial |
$95.56
|
| Rate for Payer: United Healthcare Medicare |
$40.02
|
|
|
CLOBETASOL 0.05 % SCLP SOLN
|
Facility
|
IP
|
$121.28
|
|
|
Service Code
|
NDC 68462053228
|
| Hospital Charge Code |
9632
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.96 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Aetna Commercial |
$104.78
|
| Rate for Payer: Cash Price |
$75.19
|
| Rate for Payer: Cigna All Commercial |
$104.66
|
| Rate for Payer: CORVEL All Commercial |
$112.79
|
| Rate for Payer: Coventry All Commercial |
$106.72
|
| Rate for Payer: Encore All Commercial |
$111.63
|
| Rate for Payer: Frontpath All Commercial |
$111.57
|
| Rate for Payer: Humana ChoiceCare |
$104.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.15
|
| Rate for Payer: PHCS All Commercial |
$90.96
|
| Rate for Payer: PHP All Commercial |
$91.97
|
| Rate for Payer: Sagamore Health Network All Products |
$93.62
|
| Rate for Payer: Signature Care EPO |
$100.66
|
| Rate for Payer: Signature Care PPO |
$106.72
|
| Rate for Payer: United Healthcare Commercial |
$95.56
|
|
|
CLOBETASOL 0.05 % TOP CREA
|
Facility
|
OP
|
$32.66
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
9630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna Commercial |
$27.56
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.85
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Centivo All Commercial |
$16.65
|
| 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 |
$16.65
|
| Rate for Payer: Lucent All Commercial |
$16.65
|
| 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 |
$10.78
|
|
|
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 |
$20.25
|
| 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 OINT
|
Facility
|
OP
|
$24.15
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Medicare |
$7.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.77
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Centivo All Commercial |
$12.32
|
| Rate for Payer: Cigna All Commercial |
$20.84
|
| Rate for Payer: CORVEL All Commercial |
$22.46
|
| Rate for Payer: Coventry All Commercial |
$21.25
|
| Rate for Payer: Encore All Commercial |
$22.23
|
| Rate for Payer: Frontpath All Commercial |
$22.22
|
| Rate for Payer: Humana ChoiceCare |
$20.86
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Lucent All Commercial |
$12.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.74
|
| Rate for Payer: PHCS All Commercial |
$18.11
|
| Rate for Payer: PHP All Commercial |
$18.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.42
|
| Rate for Payer: Sagamore Health Network All Products |
$18.64
|
| Rate for Payer: Signature Care EPO |
$20.04
|
| Rate for Payer: Signature Care PPO |
$21.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.53
|
| Rate for Payer: United Healthcare Commercial |
$19.03
|
| Rate for Payer: United Healthcare Medicare |
$7.97
|
|
|
CLOBETASOL 0.05 % TOP OINT
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
9631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Aetna Commercial |
$20.87
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cigna All Commercial |
$20.84
|
| Rate for Payer: CORVEL All Commercial |
$22.46
|
| Rate for Payer: Coventry All Commercial |
$21.25
|
| Rate for Payer: Encore All Commercial |
$22.23
|
| Rate for Payer: Frontpath All Commercial |
$22.22
|
| Rate for Payer: Humana ChoiceCare |
$20.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.74
|
| Rate for Payer: PHCS All Commercial |
$18.11
|
| Rate for Payer: PHP All Commercial |
$18.32
|
| Rate for Payer: Sagamore Health Network All Products |
$18.64
|
| Rate for Payer: Signature Care EPO |
$20.04
|
| Rate for Payer: Signature Care PPO |
$21.25
|
| Rate for Payer: United Healthcare Commercial |
$19.03
|
|
|
CLONAZEPAM 0.5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687054401
|
| 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 |
$2.48
|
| 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 60687054401
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| 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 |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| 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 |
$1.32
|
|
|
CLONAZEPAM 0.5 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687054411
|
| Hospital Charge Code |
9637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| 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 |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| 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 |
$1.32
|
|
|
CLONAZEPAM 0.5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687054411
|
| 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 |
$2.48
|
| 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
|
IP
|
$48.76
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$45.34 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$30.23
|
| Rate for Payer: Cigna All Commercial |
$42.08
|
| Rate for Payer: CORVEL All Commercial |
$45.34
|
| Rate for Payer: Coventry All Commercial |
$42.90
|
| Rate for Payer: Encore All Commercial |
$44.88
|
| Rate for Payer: Frontpath All Commercial |
$44.85
|
| Rate for Payer: Humana ChoiceCare |
$42.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.88
|
| Rate for Payer: PHCS All Commercial |
$36.57
|
| Rate for Payer: PHP All Commercial |
$36.98
|
| Rate for Payer: Sagamore Health Network All Products |
$37.64
|
| Rate for Payer: Signature Care EPO |
$40.47
|
| Rate for Payer: Signature Care PPO |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$38.42
|
|
|
CLONIDINE 0.1 MG/24 HR TD PTWK
|
Facility
|
OP
|
$48.76
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
27505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$45.34 |
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: Aetna Medicare |
$16.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.70
|
| Rate for Payer: Cash Price |
$30.23
|
| Rate for Payer: Centivo All Commercial |
$24.87
|
| Rate for Payer: Cigna All Commercial |
$42.08
|
| Rate for Payer: CORVEL All Commercial |
$45.34
|
| Rate for Payer: Coventry All Commercial |
$42.90
|
| Rate for Payer: Encore All Commercial |
$44.88
|
| Rate for Payer: Frontpath All Commercial |
$44.85
|
| Rate for Payer: Humana ChoiceCare |
$42.11
|
| Rate for Payer: Humana Medicare |
$24.87
|
| Rate for Payer: Lucent All Commercial |
$24.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.88
|
| Rate for Payer: PHCS All Commercial |
$36.57
|
| Rate for Payer: PHP All Commercial |
$36.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.01
|
| Rate for Payer: Sagamore Health Network All Products |
$37.64
|
| Rate for Payer: Signature Care EPO |
$40.47
|
| Rate for Payer: Signature Care PPO |
$42.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.44
|
| Rate for Payer: United Healthcare Commercial |
$38.42
|
| Rate for Payer: United Healthcare Medicare |
$16.09
|
|
|
CLONIDINE HCL 0.1 MG ORAL TAB
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Centivo All Commercial |
$0.98
|
| Rate for Payer: Cigna All Commercial |
$1.66
|
| Rate for Payer: CORVEL All Commercial |
$1.78
|
| Rate for Payer: Coventry All Commercial |
$1.69
|
| Rate for Payer: Encore All Commercial |
$1.77
|
| Rate for Payer: Frontpath All Commercial |
$1.76
|
| Rate for Payer: Humana ChoiceCare |
$1.66
|
| Rate for Payer: Humana Medicare |
$0.98
|
| Rate for Payer: Lucent All Commercial |
$0.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.73
|
| Rate for Payer: PHCS All Commercial |
$1.44
|
| Rate for Payer: PHP All Commercial |
$1.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1.48
|
| Rate for Payer: Signature Care EPO |
$1.59
|
| Rate for Payer: Signature Care PPO |
$1.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
|
|
CLONIDINE HCL 0.1 MG ORAL TAB
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
1755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna All Commercial |
$1.66
|
| Rate for Payer: CORVEL All Commercial |
$1.78
|
| Rate for Payer: Coventry All Commercial |
$1.69
|
| Rate for Payer: Encore All Commercial |
$1.77
|
| Rate for Payer: Frontpath All Commercial |
$1.76
|
| Rate for Payer: Humana ChoiceCare |
$1.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.73
|
| Rate for Payer: PHCS All Commercial |
$1.44
|
| Rate for Payer: PHP All Commercial |
$1.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1.48
|
| Rate for Payer: Signature Care EPO |
$1.59
|
| Rate for Payer: Signature Care PPO |
$1.69
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPID SOLN
|
Facility
|
OP
|
$208.11
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$193.54 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$68.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.54
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: Centivo All Commercial |
$106.14
|
| Rate for Payer: Cigna All Commercial |
$179.60
|
| Rate for Payer: CORVEL All Commercial |
$193.54
|
| Rate for Payer: Coventry All Commercial |
$183.14
|
| Rate for Payer: Encore All Commercial |
$191.57
|
| Rate for Payer: Frontpath All Commercial |
$191.46
|
| Rate for Payer: Humana ChoiceCare |
$179.74
|
| Rate for Payer: Humana Medicare |
$106.14
|
| Rate for Payer: Lucent All Commercial |
$106.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.30
|
| Rate for Payer: PHCS All Commercial |
$156.08
|
| Rate for Payer: PHP All Commercial |
$157.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.16
|
| Rate for Payer: Sagamore Health Network All Products |
$160.66
|
| Rate for Payer: Signature Care EPO |
$172.73
|
| Rate for Payer: Signature Care PPO |
$183.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.89
|
| Rate for Payer: United Healthcare Commercial |
$163.99
|
| Rate for Payer: United Healthcare Medicare |
$68.68
|
|
|
CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPID SOLN
|
Facility
|
IP
|
$208.11
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
19333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.08 |
| Max. Negotiated Rate |
$193.54 |
| Rate for Payer: Aetna Commercial |
$179.81
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: Cigna All Commercial |
$179.60
|
| Rate for Payer: CORVEL All Commercial |
$193.54
|
| Rate for Payer: Coventry All Commercial |
$183.14
|
| Rate for Payer: Encore All Commercial |
$191.57
|
| Rate for Payer: Frontpath All Commercial |
$191.46
|
| Rate for Payer: Humana ChoiceCare |
$179.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.30
|
| Rate for Payer: PHCS All Commercial |
$156.08
|
| Rate for Payer: PHP All Commercial |
$157.83
|
| Rate for Payer: Sagamore Health Network All Products |
$160.66
|
| Rate for Payer: Signature Care EPO |
$172.73
|
| Rate for Payer: Signature Care PPO |
$183.14
|
| Rate for Payer: United Healthcare Commercial |
$163.99
|
|
|
CLOPIDOGREL 75 MG ORAL TAB
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna Commercial |
$1.00
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Centivo All Commercial |
$0.61
|
| Rate for Payer: Cigna All Commercial |
$1.03
|
| Rate for Payer: CORVEL All Commercial |
$1.11
|
| Rate for Payer: Coventry All Commercial |
$1.05
|
| Rate for Payer: Encore All Commercial |
$1.10
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.03
|
| Rate for Payer: Humana Medicare |
$0.61
|
| Rate for Payer: Lucent All Commercial |
$0.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.07
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.46
|
| Rate for Payer: Sagamore Health Network All Products |
$0.92
|
| Rate for Payer: Signature Care EPO |
$0.99
|
| Rate for Payer: Signature Care PPO |
$1.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
|
|
CLOPIDOGREL 75 MG ORAL TAB
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 00904629461
|
| Hospital Charge Code |
22142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna All Commercial |
$1.03
|
| Rate for Payer: CORVEL All Commercial |
$1.11
|
| Rate for Payer: Coventry All Commercial |
$1.05
|
| Rate for Payer: Encore All Commercial |
$1.10
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.07
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$0.92
|
| Rate for Payer: Signature Care EPO |
$0.99
|
| Rate for Payer: Signature Care PPO |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
|
