|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 0904744261
|
| Hospital Charge Code |
0904744261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 5281718010
|
| Hospital Charge Code |
5281718010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 0228212710
|
| Hospital Charge Code |
0228212710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 5026819211
|
| Hospital Charge Code |
5026819211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 5281718000
|
| Hospital Charge Code |
5281718000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 6068711301
|
| Hospital Charge Code |
6068711301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 5281718000
|
| Hospital Charge Code |
5281718000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
|
CLONIDINE HCL 0.1 MG PO TABS
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 0228212710
|
| Hospital Charge Code |
0228212710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 5281718100
|
| Hospital Charge Code |
5281718100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 6068712401
|
| Hospital Charge Code |
6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 6068712411
|
| Hospital Charge Code |
6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 5281718110
|
| Hospital Charge Code |
5281718110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 6068712401
|
| Hospital Charge Code |
6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 5281718100
|
| Hospital Charge Code |
5281718100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 5281718110
|
| Hospital Charge Code |
5281718110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
|
|
CLONIDINE HCL 0.2 MG PO TABS
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 6068712411
|
| Hospital Charge Code |
6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
CLONIDINE HCL 0.3 MG PO TABS
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 5281718210
|
| Hospital Charge Code |
5281718210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
CLONIDINE HCL 0.3 MG PO TABS
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 5281718210
|
| Hospital Charge Code |
5281718210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
CLONIDINE HCL 0.3 MG PO TABS
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 0228212910
|
| Hospital Charge Code |
0228212910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
CLONIDINE HCL 0.3 MG PO TABS
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 0228212910
|
| Hospital Charge Code |
0228212910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
CLOPIDOGREL BISULFATE 75 MG PO TABS
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 5022812405
|
| Hospital Charge Code |
5022812405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Brighton Health Commercial |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.52
|
|
|
CLOPIDOGREL BISULFATE 75 MG PO TABS
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 5022812405
|
| Hospital Charge Code |
5022812405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
|
|
CLOPIDOGREL BISULFATE 75 MG PO TABS
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 6787727690
|
| Hospital Charge Code |
6787727690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
|
|
CLOPIDOGREL BISULFATE 75 MG PO TABS
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 5511119690
|
| Hospital Charge Code |
5511119690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
|
|
CLOPIDOGREL BISULFATE 75 MG PO TABS
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 6787727690
|
| Hospital Charge Code |
6787727690
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Brighton Health Commercial |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.53
|
|
