|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
OP
|
$15.92
|
|
|
Service Code
|
NDC 51862-453-04
|
| Hospital Charge Code |
1743456
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.49
|
| Rate for Payer: BCBS Transplant Transplant |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$11.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.30
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Media |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.37
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.53
|
| Rate for Payer: Vantage Medical Group Senior |
$13.53
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
IP
|
$15.92
|
|
|
Service Code
|
NDC 51862-453-04
|
| Hospital Charge Code |
1743456
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.15
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Blue Shield of California Commercial |
$38.12
|
| Rate for Payer: Blue Shield of California EPN |
$27.41
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.90
|
| Rate for Payer: BCBS Transplant Transplant |
$32.12
|
| Rate for Payer: Blue Shield of California Commercial |
$39.46
|
| Rate for Payer: Blue Shield of California EPN |
$31.27
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Media |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.77
|
| Rate for Payer: United Healthcare All Other HMO |
$26.77
|
| Rate for Payer: United Healthcare HMO Rider |
$26.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.97
|
| Rate for Payer: BCBS Transplant Transplant |
$16.08
|
| Rate for Payer: Blue Shield of California Commercial |
$19.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.65
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.76
|
| Rate for Payer: Cigna of CA PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.78
|
| Rate for Payer: Dignity Health Media |
$22.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.78
|
| Rate for Payer: Global Benefits Group Commercial |
$16.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Commercial |
$22.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.78
|
| Rate for Payer: Vantage Medical Group Senior |
$22.78
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Blue Shield of California Commercial |
$38.12
|
| Rate for Payer: Blue Shield of California EPN |
$27.41
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-01
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.97
|
| Rate for Payer: BCBS Transplant Transplant |
$16.08
|
| Rate for Payer: Blue Shield of California Commercial |
$19.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.65
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.76
|
| Rate for Payer: Cigna of CA PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.78
|
| Rate for Payer: Dignity Health Media |
$22.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.78
|
| Rate for Payer: Global Benefits Group Commercial |
$16.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Commercial |
$22.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.78
|
| Rate for Payer: Vantage Medical Group Senior |
$22.78
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$53.54
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Blue Shield of California Commercial |
$38.12
|
| Rate for Payer: Blue Shield of California EPN |
$27.41
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$53.54
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.90
|
| Rate for Payer: BCBS Transplant Transplant |
$32.12
|
| Rate for Payer: Blue Shield of California Commercial |
$39.46
|
| Rate for Payer: Blue Shield of California EPN |
$31.27
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Media |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.77
|
| Rate for Payer: United Healthcare All Other HMO |
$26.77
|
| Rate for Payer: United Healthcare HMO Rider |
$26.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-01
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Blue Shield of California Commercial |
$19.08
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.76
|
| Rate for Payer: Cigna of CA PPO |
$18.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.78
|
| Rate for Payer: Global Benefits Group Commercial |
$16.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Commercial |
$22.78
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.90
|
| Rate for Payer: BCBS Transplant Transplant |
$32.12
|
| Rate for Payer: Blue Shield of California Commercial |
$39.46
|
| Rate for Payer: Blue Shield of California EPN |
$31.27
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO |
$37.48
|
| Rate for Payer: Cigna of CA PPO |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Media |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$45.51
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.83
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.77
|
| Rate for Payer: United Healthcare All Other HMO |
$26.77
|
| Rate for Payer: United Healthcare HMO Rider |
$26.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
OP
|
$146.61
|
|
|
Service Code
|
NDC 0597-0032-34
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.19 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Galaxy Health WC |
$124.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$124.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.35
|
| Rate for Payer: BCBS Transplant Transplant |
$87.97
|
| Rate for Payer: Blue Shield of California Commercial |
$108.05
|
| Rate for Payer: Blue Shield of California EPN |
$85.62
|
| Rate for Payer: Cash Price |
$65.97
|
| Rate for Payer: Cigna of CA HMO |
$102.63
|
| Rate for Payer: Cigna of CA PPO |
$102.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.62
|
| Rate for Payer: Dignity Health Media |
$124.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.64
|
| Rate for Payer: Global Benefits Group Commercial |
$87.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$109.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$117.29
|
| Rate for Payer: Networks By Design Commercial |
$95.30
|
| Rate for Payer: Prime Health Services Commercial |
$124.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.30
|
| Rate for Payer: United Healthcare All Other HMO |
$73.30
|
| Rate for Payer: United Healthcare HMO Rider |
$73.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.62
|
| Rate for Payer: Vantage Medical Group Senior |
$124.62
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Blue Shield of California Commercial |
$19.08
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.76
|
| Rate for Payer: Cigna of CA PPO |
$18.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.78
|
| Rate for Payer: Global Benefits Group Commercial |
$16.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Commercial |
$22.78
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
IP
|
$146.61
|
|
|
Service Code
|
NDC 0597-0032-34
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.19 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Blue Shield of California Commercial |
$104.39
|
| Rate for Payer: Blue Shield of California EPN |
$75.06
|
| Rate for Payer: Cash Price |
$65.97
|
| Rate for Payer: Cigna of CA HMO |
$102.63
|
| Rate for Payer: Cigna of CA PPO |
$102.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.64
|
| Rate for Payer: Galaxy Health WC |
$124.62
|
| Rate for Payer: Global Benefits Group Commercial |
$87.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$117.29
|
| Rate for Payer: Networks By Design Commercial |
$95.30
|
| Rate for Payer: Prime Health Services Commercial |
$124.62
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
OP
|
$203.38
|
|
|
Service Code
|
NDC 0597-0033-34
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$172.87 |
| Rate for Payer: BCBS Transplant Transplant |
$122.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$172.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.17
|
| Rate for Payer: Blue Shield of California Commercial |
$149.89
|
| Rate for Payer: Blue Shield of California EPN |
$118.77
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cigna of CA HMO |
$142.37
|
| Rate for Payer: Cigna of CA PPO |
$142.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.87
|
| Rate for Payer: Dignity Health Media |
$172.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$81.35
|
| Rate for Payer: Galaxy Health WC |
$172.87
|
| Rate for Payer: Global Benefits Group Commercial |
$122.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$152.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.81
|
| Rate for Payer: Multiplan Commercial |
$162.70
|
| Rate for Payer: Networks By Design Commercial |
$132.20
|
| Rate for Payer: Prime Health Services Commercial |
$172.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$122.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.69
|
| Rate for Payer: United Healthcare All Other HMO |
$101.69
|
| Rate for Payer: United Healthcare HMO Rider |
$101.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.87
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
IP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.04
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$26.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$31.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: Networks By Design Commercial |
$24.17
|
| Rate for Payer: Prime Health Services Commercial |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
IP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.04
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$26.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$31.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: Networks By Design Commercial |
$24.17
|
| Rate for Payer: Prime Health Services Commercial |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
OP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.25
|
| Rate for Payer: BCBS Transplant Transplant |
$44.56
|
| Rate for Payer: Blue Shield of California Commercial |
$54.74
|
| Rate for Payer: Blue Shield of California EPN |
$43.37
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$51.99
|
| Rate for Payer: Cigna of CA PPO |
$51.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.13
|
| Rate for Payer: Dignity Health Media |
$63.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.71
|
| Rate for Payer: Galaxy Health WC |
$63.13
|
| Rate for Payer: Global Benefits Group Commercial |
$44.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$59.42
|
| Rate for Payer: Networks By Design Commercial |
$48.28
|
| Rate for Payer: Prime Health Services Commercial |
$63.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$44.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.14
|
| Rate for Payer: United Healthcare All Other HMO |
$37.14
|
| Rate for Payer: United Healthcare HMO Rider |
$37.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.13
|
| Rate for Payer: Vantage Medical Group Senior |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Blue Shield of California Commercial |
$52.88
|
| Rate for Payer: Blue Shield of California EPN |
$38.03
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$51.99
|
| Rate for Payer: Cigna of CA PPO |
$51.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: Galaxy Health WC |
$63.13
|
| Rate for Payer: Global Benefits Group Commercial |
$44.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$59.42
|
| Rate for Payer: Networks By Design Commercial |
$48.28
|
| Rate for Payer: Prime Health Services Commercial |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
OP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.25
|
| Rate for Payer: BCBS Transplant Transplant |
$44.56
|
| Rate for Payer: Blue Shield of California Commercial |
$54.74
|
| Rate for Payer: Blue Shield of California EPN |
$43.37
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$51.99
|
| Rate for Payer: Cigna of CA PPO |
$51.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.13
|
| Rate for Payer: Dignity Health Media |
$63.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.71
|
| Rate for Payer: Galaxy Health WC |
$63.13
|
| Rate for Payer: Global Benefits Group Commercial |
$44.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$59.42
|
| Rate for Payer: Networks By Design Commercial |
$48.28
|
| Rate for Payer: Prime Health Services Commercial |
$63.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$44.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.14
|
| Rate for Payer: United Healthcare All Other HMO |
$37.14
|
| Rate for Payer: United Healthcare HMO Rider |
$37.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.13
|
| Rate for Payer: Vantage Medical Group Senior |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
IP
|
$203.38
|
|
|
Service Code
|
NDC 0597-0033-34
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$172.87 |
| Rate for Payer: Blue Shield of California Commercial |
$144.81
|
| Rate for Payer: Blue Shield of California EPN |
$104.13
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cigna of CA HMO |
$142.37
|
| Rate for Payer: Cigna of CA PPO |
$142.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.35
|
| Rate for Payer: Galaxy Health WC |
$172.87
|
| Rate for Payer: Global Benefits Group Commercial |
$122.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.81
|
| Rate for Payer: Multiplan Commercial |
$162.70
|
| Rate for Payer: Networks By Design Commercial |
$132.20
|
| Rate for Payer: Prime Health Services Commercial |
$172.87
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.15
|
| Rate for Payer: BCBS Transplant Transplant |
$22.31
|
| Rate for Payer: Blue Shield of California Commercial |
$27.40
|
| Rate for Payer: Blue Shield of California EPN |
$21.71
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$26.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.60
|
| Rate for Payer: Dignity Health Media |
$31.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$31.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: Networks By Design Commercial |
$24.17
|
| Rate for Payer: Prime Health Services Commercial |
$31.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.60
|
| Rate for Payer: Vantage Medical Group Senior |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.15
|
| Rate for Payer: BCBS Transplant Transplant |
$22.31
|
| Rate for Payer: Blue Shield of California Commercial |
$27.40
|
| Rate for Payer: Blue Shield of California EPN |
$21.71
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$26.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.60
|
| Rate for Payer: Dignity Health Media |
$31.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$31.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: Networks By Design Commercial |
$24.17
|
| Rate for Payer: Prime Health Services Commercial |
$31.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.60
|
| Rate for Payer: Vantage Medical Group Senior |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Blue Shield of California Commercial |
$52.88
|
| Rate for Payer: Blue Shield of California EPN |
$38.03
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$51.99
|
| Rate for Payer: Cigna of CA PPO |
$51.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: Galaxy Health WC |
$63.13
|
| Rate for Payer: Global Benefits Group Commercial |
$44.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$59.42
|
| Rate for Payer: Networks By Design Commercial |
$48.28
|
| Rate for Payer: Prime Health Services Commercial |
$63.13
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
OP
|
$0.37
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
1712037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
