|
CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]
|
Facility
|
OP
|
$8.55
|
|
|
Service Code
|
NDC 21922001605
|
| Hospital Charge Code |
21922001605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Brighton Health Commercial |
$6.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.81
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.56
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]
|
Facility
|
OP
|
$8.55
|
|
|
Service Code
|
NDC 21922001604
|
| Hospital Charge Code |
21922001604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Brighton Health Commercial |
$6.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.81
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.56
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]
|
Facility
|
OP
|
$8.55
|
|
|
Service Code
|
NDC 68180095601
|
| Hospital Charge Code |
68180095601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Brighton Health Commercial |
$6.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.81
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$2.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.56
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX OINT [9631]
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
NDC 51672125903
|
| Hospital Charge Code |
51672125903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.33
|
| Rate for Payer: Aetna Government |
$4.33
|
| Rate for Payer: Brighton Health Commercial |
$6.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.89
|
| Rate for Payer: Group Health Inc Commercial |
$4.33
|
| Rate for Payer: Group Health Inc Medicare |
$3.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.63
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX OINT [9631]
|
Facility
|
OP
|
$8.31
|
|
|
Service Code
|
NDC 21922001707
|
| Hospital Charge Code |
21922001707
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna Government |
$4.16
|
| Rate for Payer: Brighton Health Commercial |
$6.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.16
|
| Rate for Payer: Group Health Inc Medicare |
$2.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.40
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX OINT [9631]
|
Facility
|
OP
|
$9.95
|
|
|
Service Code
|
NDC 21922001704
|
| Hospital Charge Code |
21922001704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.97
|
| Rate for Payer: Aetna Government |
$4.97
|
| Rate for Payer: Brighton Health Commercial |
$7.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.77
|
| Rate for Payer: Group Health Inc Commercial |
$4.97
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX OINT [9631]
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
NDC 43386009662
|
| Hospital Charge Code |
43386009662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.33
|
| Rate for Payer: Aetna Government |
$4.33
|
| Rate for Payer: Brighton Health Commercial |
$6.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.89
|
| Rate for Payer: Group Health Inc Commercial |
$4.33
|
| Rate for Payer: Group Health Inc Medicare |
$3.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.63
|
|
|
CLOBETASOL PROPIONATE 0.05 % EX OINT [9631]
|
Facility
|
OP
|
$10.36
|
|
|
Service Code
|
NDC 51672125901
|
| Hospital Charge Code |
51672125901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Brighton Health Commercial |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.05
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$3.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.74
|
|
|
CLOBETASOL PROPIONATE 0.05% OINTMENT
|
Facility
|
OP
|
$11.48
|
|
| Hospital Charge Code |
41652946
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Brighton Health Commercial |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.81
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.46
|
|
|
CLOBETASOL PROPIONATE 0.05% OINTMENT
|
Facility
|
OP
|
$11.48
|
|
| Hospital Charge Code |
41642946
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Brighton Health Commercial |
$8.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.81
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.46
|
|
|
CLOMIPRAMINE 25 MG CAP
|
Facility
|
OP
|
$0.43
|
|
| Hospital Charge Code |
41654042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
CLOMIPRAMINE 25 MG CAP
|
Facility
|
OP
|
$0.43
|
|
| Hospital Charge Code |
41644042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
CLONAZEPAM 0.5 MG PO TABS [9637]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 16729013600
|
| Hospital Charge Code |
16729013600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
CLONAZEPAM 0.5 MG PO TABS [9637]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 43547040610
|
| Hospital Charge Code |
43547040610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
CLONAZEPAM 0.5 MG PO TABS [9637]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
00904722761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.41
|
|
|
CLONAZEPAM 0.5 MG PO TABS [9637]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
60687054401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
CLONAZEPAM 0.5 MG TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41644265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
CLONAZEPAM 0.5 MG TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41654265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
CLONAZEPAM 1 MG PO TABS [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687055511
|
| Hospital Charge Code |
60687055511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
CLONAZEPAM 1 MG PO TABS [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687055501
|
| Hospital Charge Code |
60687055501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
CLONAZEPAM 1 MG PO TABS [9638]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 16729013700
|
| Hospital Charge Code |
16729013700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.56
|
|
|
CLONAZEPAM 1 MG TAB
|
Facility
|
OP
|
$0.12
|
|
| Hospital Charge Code |
41644264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
CLONAZEPAM 1 MG TAB
|
Facility
|
OP
|
$0.12
|
|
| Hospital Charge Code |
41654264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
CLONIDINE 0.1 MG/24HR TD PTWK [162634]
|
Facility
|
OP
|
$33.12
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
00378087199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.56
|
| Rate for Payer: Aetna Government |
$16.56
|
| Rate for Payer: Brighton Health Commercial |
$24.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.52
|
| Rate for Payer: Group Health Inc Commercial |
$16.56
|
| Rate for Payer: Group Health Inc Medicare |
$11.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.53
|
|
|
CLONIDINE 0.1 MG/24HR TD PTWK [162634]
|
Facility
|
OP
|
$33.16
|
|
|
Service Code
|
NDC 51862045301
|
| Hospital Charge Code |
51862045301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.58
|
| Rate for Payer: Aetna Government |
$16.58
|
| Rate for Payer: Brighton Health Commercial |
$24.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.55
|
| Rate for Payer: Group Health Inc Commercial |
$16.58
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.55
|
|
