|
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [HMC]
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
NDC 00338954924
|
| Hospital Charge Code |
3808417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.68
|
| Rate for Payer: WPPA Medicare Advantage |
$28.02
|
|
|
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [HMC]
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
NDC 00338954924
|
| Hospital Charge Code |
3808417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.37
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clindamycin 600 mg-5%/50 mL Sol [HMC]
|
Facility
|
OP
|
$54.52
|
|
|
Service Code
|
NDC 00781328909
|
| Hospital Charge Code |
3808419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$51.79 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Humana Medicare Advantage |
$22.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.81
|
| Rate for Payer: WPPA Medicare Advantage |
$32.71
|
|
|
clindamycin 600 mg-5%/50 mL Sol [HMC]
|
Facility
|
IP
|
$54.52
|
|
|
Service Code
|
NDC 00781328909
|
| Hospital Charge Code |
3808419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.79
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clobetasol topical 0.05% Oin [HMC]
|
Facility
|
OP
|
$378.73
|
|
|
Service Code
|
NDC 21922001706
|
| Hospital Charge Code |
3800327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.49 |
| Max. Negotiated Rate |
$359.79 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Humana Medicare Advantage |
$159.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$359.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.49
|
| Rate for Payer: WPPA Medicare Advantage |
$227.24
|
|
|
clobetasol topical 0.05% Oin [HMC]
|
Facility
|
OP
|
$370.66
|
|
|
Service Code
|
NDC 51672125902
|
| Hospital Charge Code |
3800327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$352.13 |
| Rate for Payer: Aetna Commercial |
$333.59
|
| Rate for Payer: Humana Medicare Advantage |
$155.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$352.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.26
|
| Rate for Payer: WPPA Medicare Advantage |
$222.40
|
|
|
clobetasol topical 0.05% Oin [HMC]
|
Facility
|
IP
|
$378.73
|
|
|
Service Code
|
NDC 21922001706
|
| Hospital Charge Code |
3800327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$340.86 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$359.79
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clobetasol topical 0.05% Oin [HMC]
|
Facility
|
IP
|
$370.66
|
|
|
Service Code
|
NDC 51672125902
|
| Hospital Charge Code |
3800327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$333.59 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$333.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$352.13
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clonazePAM 0.5 mg Disintegrating Tab [HMC]
|
Facility
|
OP
|
$18.89
|
|
|
Service Code
|
NDC 49884030802
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Humana Medicare Advantage |
$7.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.56
|
| Rate for Payer: WPPA Medicare Advantage |
$11.33
|
|
|
clonazePAM 0.5 mg Disintegrating Tab [HMC]
|
Facility
|
IP
|
$18.89
|
|
|
Service Code
|
NDC 49884030802
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
IP
|
$7.12
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.76
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
OP
|
$7.12
|
|
|
Service Code
|
NDC 60687054401
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: Humana Medicare Advantage |
$2.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.85
|
| Rate for Payer: WPPA Medicare Advantage |
$4.27
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
IP
|
$7.25
|
|
|
Service Code
|
NDC 00093083201
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.89
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
OP
|
$6.88
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$6.19
|
| Rate for Payer: Humana Medicare Advantage |
$2.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.75
|
| Rate for Payer: WPPA Medicare Advantage |
$4.13
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
IP
|
$6.88
|
|
|
Service Code
|
NDC 00904722761
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.54
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
clonazePAM 0.5 mg Tab [HMC]
|
Facility
|
OP
|
$7.25
|
|
|
Service Code
|
NDC 00093083201
|
| Hospital Charge Code |
3808591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$6.89 |
| Rate for Payer: Aetna Commercial |
$6.53
|
| Rate for Payer: Humana Medicare Advantage |
$3.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.90
|
| Rate for Payer: WPPA Medicare Advantage |
$4.35
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$36.21 |
| Rate for Payer: Aetna Commercial |
$34.31
|
| Rate for Payer: Humana Medicare Advantage |
$16.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.25
|
| Rate for Payer: WPPA Medicare Advantage |
$22.87
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
NDC 00555100916
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$34.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$34.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.21
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
NDC 00555100916
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna Commercial |
$34.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.26
|
| Rate for Payer: WPPA Medicare Advantage |
$22.90
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$34.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.21
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
cloNIDine 0.1 mg/24 hr Transderm ER Film [HMC]
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 00378087199
|
| Hospital Charge Code |
3808240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$36.21 |
| Rate for Payer: Aetna Commercial |
$34.31
|
| Rate for Payer: Humana Medicare Advantage |
$16.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.25
|
| Rate for Payer: WPPA Medicare Advantage |
$22.87
|
|
|
cloNIDine 0.1 mg Tab [HMC]
|
Facility
|
IP
|
$5.73
|
|
|
Service Code
|
NDC 68001023700
|
| Hospital Charge Code |
3804883
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.44
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
cloNIDine 0.1 mg Tab [HMC]
|
Facility
|
OP
|
$6.10
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
3804883
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Humana Medicare Advantage |
$2.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.44
|
| Rate for Payer: WPPA Medicare Advantage |
$3.66
|
|
|
cloNIDine 0.1 mg Tab [HMC]
|
Facility
|
IP
|
$6.10
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
3804883
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.79
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
