|
CLONIDINE 0.1 MG/24HR TD PTWK [162634]
|
Facility
|
OP
|
$33.12
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
00591350804
|
|
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/ML SUSP
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41654800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CLONIDINE 0.1 MG/ML SUSP
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41644800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CLONIDINE 0.1 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653584
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.1 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643584
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.1 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$34.02
|
|
| Hospital Charge Code |
41651028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$27.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.01
|
| Rate for Payer: Aetna Government |
$17.01
|
| Rate for Payer: Brighton Health Commercial |
$25.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.01
|
| Rate for Payer: Group Health Inc Medicare |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.11
|
|
|
CLONIDINE 0.1 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$34.02
|
|
| Hospital Charge Code |
41641028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$27.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.01
|
| Rate for Payer: Aetna Government |
$17.01
|
| Rate for Payer: Brighton Health Commercial |
$25.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.01
|
| Rate for Payer: Group Health Inc Medicare |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.11
|
|
|
CLONIDINE 0.2 MG/24HR TD PTWK [162635]
|
Facility
|
OP
|
$55.77
|
|
|
Service Code
|
NDC 00378087299
|
| Hospital Charge Code |
00378087299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$44.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.88
|
| Rate for Payer: Aetna Government |
$27.88
|
| Rate for Payer: Brighton Health Commercial |
$41.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.92
|
| Rate for Payer: Group Health Inc Commercial |
$27.88
|
| Rate for Payer: Group Health Inc Medicare |
$19.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.25
|
|
|
CLONIDINE 0.2 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653518
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.2 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643518
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.2 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$57.27
|
|
| Hospital Charge Code |
41641024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.64
|
| Rate for Payer: Aetna Government |
$28.64
|
| Rate for Payer: Brighton Health Commercial |
$42.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.94
|
| Rate for Payer: Group Health Inc Commercial |
$28.64
|
| Rate for Payer: Group Health Inc Medicare |
$20.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.23
|
|
|
CLONIDINE 0.2 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$57.27
|
|
| Hospital Charge Code |
41651024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$45.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.64
|
| Rate for Payer: Aetna Government |
$28.64
|
| Rate for Payer: Brighton Health Commercial |
$42.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.94
|
| Rate for Payer: Group Health Inc Commercial |
$28.64
|
| Rate for Payer: Group Health Inc Medicare |
$20.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.23
|
|
|
CLONIDINE 0.3 MG/24HR TD PTWK [162636]
|
Facility
|
OP
|
$77.36
|
|
|
Service Code
|
NDC 00378087399
|
| Hospital Charge Code |
00378087399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$61.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.68
|
| Rate for Payer: Aetna Government |
$38.68
|
| Rate for Payer: Brighton Health Commercial |
$58.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.60
|
| Rate for Payer: Group Health Inc Commercial |
$38.68
|
| Rate for Payer: Group Health Inc Medicare |
$27.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.28
|
|
|
CLONIDINE 0.3 MG/24HR TD PTWK [162636]
|
Facility
|
OP
|
$77.45
|
|
|
Service Code
|
NDC 51862045501
|
| Hospital Charge Code |
51862045501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$61.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.72
|
| Rate for Payer: Aetna Government |
$38.72
|
| Rate for Payer: Brighton Health Commercial |
$58.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.66
|
| Rate for Payer: Group Health Inc Commercial |
$38.72
|
| Rate for Payer: Group Health Inc Medicare |
$27.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.34
|
|
|
CLONIDINE 0.3 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650322
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.3 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640322
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLONIDINE 0.3 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$79.47
|
|
| Hospital Charge Code |
41651019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$63.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.74
|
| Rate for Payer: Aetna Government |
$39.74
|
| Rate for Payer: Brighton Health Commercial |
$59.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.04
|
| Rate for Payer: Group Health Inc Commercial |
$39.74
|
| Rate for Payer: Group Health Inc Medicare |
$27.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.66
|
|
|
CLONIDINE 0.3 MG TRANSDERMAL PATCH
|
Facility
|
OP
|
$79.47
|
|
| Hospital Charge Code |
41641019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$63.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.74
|
| Rate for Payer: Aetna Government |
$39.74
|
| Rate for Payer: Brighton Health Commercial |
$59.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.04
|
| Rate for Payer: Group Health Inc Commercial |
$39.74
|
| Rate for Payer: Group Health Inc Medicare |
$27.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.66
|
|
|
CLONIDINE HCL 0.1 MG PO TABS [1755]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 52817018000
|
| Hospital Charge Code |
52817018000
|
|
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: 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 [1755]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 00228212710
|
| Hospital Charge Code |
00228212710
|
|
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: 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 [1755]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
60687011301
|
|
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: 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 [1755]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 52817018010
|
| Hospital Charge Code |
52817018010
|
|
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: 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 0.2 MG PO TABS [1756]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 52817018110
|
| Hospital Charge Code |
52817018110
|
|
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: 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 [1756]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
60687012401
|
|
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: 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 [1756]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 60687012411
|
| Hospital Charge Code |
60687012411
|
|
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: 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
|
|
