|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$146.61
|
|
|
Service Code
|
NDC 0597-0032-34
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Adventist Health Commercial |
$29.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.96
|
| Rate for Payer: Blue Shield of California Commercial |
$91.04
|
| Rate for Payer: Blue Shield of California EPN |
$86.06
|
| Rate for Payer: Cash Price |
$65.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.62
|
| Rate for Payer: Dignity Health Senior |
$124.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.75
|
| Rate for Payer: Heritage Provider Network Senior |
$90.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.65
|
| Rate for Payer: Multiplan Commercial |
$109.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.64
|
| Rate for Payer: TriValley Medical Group Senior |
$58.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.62
|
| Rate for Payer: Vantage Medical Group Senior |
$124.62
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-01
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.10
|
| Rate for Payer: Blue Shield of California Commercial |
$16.64
|
| Rate for Payer: Blue Shield of California EPN |
$15.73
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.78
|
| Rate for Payer: Dignity Health Senior |
$22.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.59
|
| Rate for Payer: Heritage Provider Network Senior |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$20.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.72
|
| Rate for Payer: TriValley Medical Group Senior |
$10.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.78
|
| Rate for Payer: Vantage Medical Group Senior |
$22.78
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.41
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Senior |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$20.10
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$26.80
|
|
|
Service Code
|
NDC 51862-454-01
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.41
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Senior |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$20.10
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.16 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.25
|
| Rate for Payer: Heritage Provider Network Senior |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.16 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.25
|
| Rate for Payer: Heritage Provider Network Senior |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.54
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.16 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.25
|
| Rate for Payer: Heritage Provider Network Senior |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.16
|
| Rate for Payer: Blue Shield of California Commercial |
$33.25
|
| Rate for Payer: Blue Shield of California EPN |
$31.43
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: Dignity Health Senior |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.14
|
| Rate for Payer: Heritage Provider Network Senior |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
NDC 0378-0872-16
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.16
|
| Rate for Payer: Blue Shield of California Commercial |
$33.25
|
| Rate for Payer: Blue Shield of California EPN |
$31.43
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: Dignity Health Senior |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.14
|
| Rate for Payer: Heritage Provider Network Senior |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$146.61
|
|
|
Service Code
|
NDC 0597-0032-34
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Adventist Health Commercial |
$29.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.72
|
| Rate for Payer: Cash Price |
$65.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.25
|
| Rate for Payer: Heritage Provider Network Senior |
$99.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.65
|
| Rate for Payer: Multiplan Commercial |
$109.96
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
NDC 0591-3509-54
|
| Hospital Charge Code |
1743457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.16
|
| Rate for Payer: Blue Shield of California Commercial |
$33.25
|
| Rate for Payer: Blue Shield of California EPN |
$31.43
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.51
|
| Rate for Payer: Dignity Health Senior |
$45.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.14
|
| Rate for Payer: Heritage Provider Network Senior |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.51
|
| Rate for Payer: Vantage Medical Group Senior |
$45.51
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$203.38
|
|
|
Service Code
|
NDC 0597-0033-34
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$172.87 |
| Rate for Payer: Adventist Health Commercial |
$40.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.54
|
| Rate for Payer: Blue Shield of California Commercial |
$126.30
|
| Rate for Payer: Blue Shield of California EPN |
$119.38
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$132.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.87
|
| Rate for Payer: Dignity Health Senior |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.89
|
| Rate for Payer: Heritage Provider Network Senior |
$125.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$98.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Multiplan Commercial |
$152.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$81.35
|
| Rate for Payer: TriValley Medical Group Senior |
$81.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.87
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.02
|
| 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: Blue Shield of California Commercial |
$46.12
|
| Rate for Payer: Blue Shield of California EPN |
$43.60
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.13
|
| Rate for Payer: Dignity Health Senior |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.97
|
| Rate for Payer: Heritage Provider Network Senior |
$45.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Multiplan Commercial |
$55.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.71
|
| Rate for Payer: TriValley Medical Group Senior |
$29.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.13
|
| Rate for Payer: Vantage Medical Group Senior |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.02
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.28
|
| Rate for Payer: Heritage Provider Network Senior |
$50.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Multiplan Commercial |
$55.70
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.02
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.28
|
| Rate for Payer: Heritage Provider Network Senior |
$50.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Multiplan Commercial |
$55.70
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.02
|
| 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: Blue Shield of California Commercial |
$46.12
|
| Rate for Payer: Blue Shield of California EPN |
$43.60
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.13
|
| Rate for Payer: Dignity Health Senior |
$63.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.97
|
| Rate for Payer: Heritage Provider Network Senior |
$45.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Multiplan Commercial |
$55.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.71
|
| Rate for Payer: TriValley Medical Group Senior |
$29.71
|
| 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 |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.54
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.17
|
| Rate for Payer: Heritage Provider Network Senior |
$25.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.54
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.17
|
| Rate for Payer: Heritage Provider Network Senior |
$25.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.54
|
| 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 |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.09
|
| Rate for Payer: Blue Shield of California EPN |
$21.82
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.60
|
| Rate for Payer: Dignity Health Senior |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.01
|
| Rate for Payer: Heritage Provider Network Senior |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.87
|
| Rate for Payer: TriValley Medical Group Senior |
$14.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.60
|
| Rate for Payer: Vantage Medical Group Senior |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.54
|
| 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 |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.09
|
| Rate for Payer: Blue Shield of California EPN |
$21.82
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.60
|
| Rate for Payer: Dignity Health Senior |
$31.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.01
|
| Rate for Payer: Heritage Provider Network Senior |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.87
|
| Rate for Payer: TriValley Medical Group Senior |
$14.87
|
| 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
|
$203.38
|
|
|
Service Code
|
NDC 0597-0033-34
|
| Hospital Charge Code |
1743458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$152.54 |
| Rate for Payer: Adventist Health Commercial |
$40.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.72
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.69
|
| Rate for Payer: Heritage Provider Network Senior |
$137.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Multiplan Commercial |
$152.54
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 62332-054-31
|
| Hospital Charge Code |
1712037
|
|
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 Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 68001-237-00
|
| Hospital Charge Code |
1712037
|
|
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 Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 62332-054-31
|
| Hospital Charge Code |
1712037
|
|
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 Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
1712037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
|
