|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687-872-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 60687-555-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 16729-137-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 72888-153-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687-555-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687-555-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 60687-555-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 0904-7728-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: InnovAge PACE Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 60687-872-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 60687-872-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 16729-137-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
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 |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| 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: Health Management Network EPO/PPO |
$0.05
|
| 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
|
|
|
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 Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| 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: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| 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: Riverside University Health System MISP |
$0.02
|
| 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
|
|
|
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 |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.02
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| 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: Health Management Network EPO/PPO |
$14.32
|
| 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 |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| 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 |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| 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 Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| 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: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: InnovAge PACE Commercial |
$7.96
|
| 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 |
$3.18
|
| 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 |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| 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 |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.02
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| 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: Health Management Network EPO/PPO |
$14.32
|
| 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 |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| 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 51862-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| 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 Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| 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: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: InnovAge PACE Commercial |
$7.96
|
| 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 |
$3.18
|
| 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 |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| 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
|
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 |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$41.38
|
| Rate for Payer: Blue Shield of California EPN |
$26.98
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| 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 |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| 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 |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.51
|
| 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 Exchange |
$25.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.71
|
| Rate for Payer: Blue Shield of California EPN |
$21.36
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| Rate for Payer: InnovAge PACE Commercial |
$26.77
|
| 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 |
$10.71
|
| 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 |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| Rate for Payer: Riverside University Health System MISP |
$21.41
|
| 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 |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.51
|
| 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 Exchange |
$25.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.71
|
| Rate for Payer: Blue Shield of California EPN |
$21.36
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| Rate for Payer: InnovAge PACE Commercial |
$26.77
|
| 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 |
$10.71
|
| 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 |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| Rate for Payer: Riverside University Health System MISP |
$21.41
|
| 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 0378-0872-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$41.38
|
| Rate for Payer: Blue Shield of California EPN |
$26.98
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| 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 |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| 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 0378-0872-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$41.38
|
| Rate for Payer: Blue Shield of California EPN |
$26.98
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| 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 |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| 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 0378-0872-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.51
|
| 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 Exchange |
$25.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.71
|
| Rate for Payer: Blue Shield of California EPN |
$21.36
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| 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: Health Management Network EPO/PPO |
$48.18
|
| Rate for Payer: InnovAge PACE Commercial |
$26.77
|
| 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 |
$10.71
|
| 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 |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| Rate for Payer: Riverside University Health System MISP |
$21.41
|
| 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 |
$14.95 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.84
|
| Rate for Payer: Blue Shield of California EPN |
$8.37
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Central Health Plan Commercial |
$13.29
|
| 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: Health Management Network EPO/PPO |
$14.95
|
| 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 |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| 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
|
$16.61
|
|
|
Service Code
|
NDC 52817-611-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.09
|
| 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 Exchange |
$8.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Central Health Plan Commercial |
$13.29
|
| 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: Health Management Network EPO/PPO |
$14.95
|
| Rate for Payer: InnovAge PACE Commercial |
$8.30
|
| 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 |
$3.32
|
| 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 |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$14.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.64
|
| 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
|
|
