|
CLINDAMYCIN 15 MG/ML SUSP
|
Facility
OP
|
$0.80
|
|
| Hospital Charge Code |
41641181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.40
|
| Rate for Payer: Aetna Government |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.52
|
|
|
CLINDAMYCIN 15 MG/ML SUSP
|
Facility
OP
|
$0.80
|
|
| Hospital Charge Code |
41651181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.40
|
| Rate for Payer: Aetna Government |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.52
|
|
|
CLINDAMYCIN 18 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 18 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 300 MG/2 ML INJ
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
CLINDAMYCIN 300 MG/2 ML INJ
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
CLINDAMYCIN 300 MG/2 ML INJ
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
|
|
CLINDAMYCIN 300 MG/2 ML INJ
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
|
|
CLINDAMYCIN 300 MG/D5W 50 ML IVPB PREMIX
|
Facility
OP
|
$15.12
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
41653044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.17
|
| Rate for Payer: Aetna Government |
$1.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$7.56
|
| Rate for Payer: Group Health Inc Medicare |
$5.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.83
|
|
|
CLINDAMYCIN 300 MG/D5W 50 ML IVPB PREMIX
|
Facility
IP
|
$15.12
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
41653044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$7.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.56
|
|
|
CLINDAMYCIN 300 MG/D5W 50 ML IVPB PREMIX
|
Facility
IP
|
$15.12
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
41643044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$7.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.56
|
|
|
CLINDAMYCIN 300 MG/D5W 50 ML IVPB PREMIX
|
Facility
OP
|
$15.12
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
41643044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.17
|
| Rate for Payer: Aetna Government |
$1.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$7.56
|
| Rate for Payer: Group Health Inc Medicare |
$5.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.83
|
|
|
CLINDAMYCIN 600MG 4ML PER ML/MG
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
41651456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.30
|
| Rate for Payer: Aetna Government |
$1.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.38
|
| Rate for Payer: SOMOS Essential |
$1.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
CLINDAMYCIN 600MG 4ML PER ML/MG
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
41651456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
CLINDAMYCIN 600MG 4ML, PER ML/MG
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
41641456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
CLINDAMYCIN 600MG 4ML, PER ML/MG
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
41641456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.30
|
| Rate for Payer: Aetna Government |
$1.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.38
|
| Rate for Payer: SOMOS Essential |
$1.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
CLINDAMYCIN 600 MG/D5W 50 ML IVPB PREMIX
|
Facility
OP
|
$26.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41651898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$9.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.05
|
|
|
CLINDAMYCIN 600 MG/D5W 50 ML IVPB PREMIX
|
Facility
OP
|
$26.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41641898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$9.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.05
|
|
|
CLINDAMYCIN 600 MG/D5W 50 ML IVPB PREMIX
|
Facility
IP
|
$26.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41651898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
|
|
CLINDAMYCIN 600 MG/D5W 50 ML IVPB PREMIX
|
Facility
IP
|
$26.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41641898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
|
|
CLINDAMYCIN 6 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41644164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 6 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41654164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 900 MG/6 ML VIAL
|
Facility
IP
|
$7.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.56
|
|
|
CLINDAMYCIN 900 MG/6 ML VIAL
|
Facility
OP
|
$7.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.56
|
| Rate for Payer: Aetna Government |
$3.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.09
|
| Rate for Payer: Group Health Inc Commercial |
$3.56
|
| Rate for Payer: Group Health Inc Medicare |
$2.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.63
|
|
|
CLINDAMYCIN 900MG/6 ML VIAL
|
Facility
IP
|
$7.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.56
|
|
