|
CLONAZEPAM 2 MG TABLET [9639]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 16729-138-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CLONAZEPAM 2 MG TABLET [9639]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 16729-138-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 51862-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Cash Price |
$8.75
|
| 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 |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| 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 |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 51862-453-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.73
|
| Rate for Payer: Cash Price |
$8.75
|
| 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 |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 51862-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.73
|
| Rate for Payer: Cash Price |
$8.75
|
| 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 |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 51862-453-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Cash Price |
$8.75
|
| 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 |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| 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 |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.87
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.47
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| 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 |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$39.51
|
| Rate for Payer: Blue Shield of California EPN |
$26.02
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$16.61
|
|
|
Service Code
|
NDC 52817-611-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.20
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$11.63
|
| Rate for Payer: Cigna of CA PPO |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.63
|
| Rate for Payer: Multiplan Commercial |
$13.29
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$14.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.30
|
| Rate for Payer: United Healthcare All Other HMO |
$8.30
|
| Rate for Payer: United Healthcare HMO Rider |
$8.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.12
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$39.51
|
| Rate for Payer: Blue Shield of California EPN |
$26.02
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$39.51
|
| Rate for Payer: Blue Shield of California EPN |
$26.02
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.87
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.47
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| 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 |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.87
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.47
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| 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 |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$16.61
|
|
|
Service Code
|
NDC 52817-611-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.07
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$11.63
|
| Rate for Payer: Cigna of CA PPO |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$13.29
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$14.12
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
NDC 0378-0872-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.87
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.47
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| 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 |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0378-0872-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$39.51
|
| Rate for Payer: Blue Shield of California EPN |
$26.02
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$37.47
|
| Rate for Payer: Cigna of CA PPO |
$37.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.85
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California EPN |
$36.10
|
| Rate for Payer: Cash Price |
$40.85
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$45.97
|
| 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
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.83
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 Medi-Cal |
$31.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.03
|
| 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: 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
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.61
|
| Rate for Payer: Cash Price |
$40.85
|
| 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 Medi-Cal |
$63.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.99
|
| 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: 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 |
$37.13
|
| Rate for Payer: United Healthcare All Other HMO |
$37.13
|
| Rate for Payer: United Healthcare HMO Rider |
$37.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.13
|
| 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
|
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.83
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 Medi-Cal |
$31.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.03
|
| 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: 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California EPN |
$36.10
|
| Rate for Payer: Cash Price |
$40.85
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$45.97
|
| 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
|
IP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: EPIC Health Plan Commercial |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$31.60
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$26.03
|
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.44
|
| Rate for Payer: Blue Shield of California EPN |
$18.07
|
| Rate for Payer: Cash Price |
$20.45
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.01
|
| 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.61
|
| Rate for Payer: Cash Price |
$40.85
|
| 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 Medi-Cal |
$63.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.71
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.99
|
| 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: 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 |
$37.13
|
| Rate for Payer: United Healthcare All Other HMO |
$37.13
|
| Rate for Payer: United Healthcare HMO Rider |
$37.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.13
|
| 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
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.44
|
| Rate for Payer: Blue Shield of California EPN |
$18.07
|
| Rate for Payer: Cash Price |
$20.45
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$23.01
|
| 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 HCL 0.1 MG TABLET [1755]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 60687-113-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
