|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$0.85
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1720474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$1.27
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1720473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1721155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
IP
|
$1.05
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1721155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Senior |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
NDG1743A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
OP
|
$2.31
|
|
|
Service Code
|
NDC 0168-0203-60
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
IP
|
$2.31
|
|
|
Service Code
|
NDC 0168-0203-60
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
OP
|
$2.34
|
|
|
Service Code
|
NDC 0009-3329-01
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.99
|
| Rate for Payer: Dignity Health Senior |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1.99
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 0009-3329-01
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
OP
|
$1.92
|
|
|
Service Code
|
NDC 59762-3744-1
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Senior |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
IP
|
$1.92
|
|
|
Service Code
|
NDC 59762-3744-1
|
| Hospital Charge Code |
1743742
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
|
|
CLINDAMYCIN 1 % TOPICAL GEL [9623]
|
Facility
OP
|
$2.76
|
|
|
Service Code
|
NDC 59762-3743-1
|
| Hospital Charge Code |
1743537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Senior |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
CLINDAMYCIN 1 % TOPICAL GEL [9623]
|
Facility
OP
|
$3.32
|
|
|
Service Code
|
NDC 0168-0202-30
|
| Hospital Charge Code |
1743537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.82
|
| Rate for Payer: Dignity Health Senior |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2.82
|
|
|
CLINDAMYCIN 1 % TOPICAL GEL [9623]
|
Facility
IP
|
$2.76
|
|
|
Service Code
|
NDC 59762-3743-1
|
| Hospital Charge Code |
1743537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
|
|
CLINDAMYCIN 1 % TOPICAL GEL [9623]
|
Facility
IP
|
$3.32
|
|
|
Service Code
|
NDC 0168-0202-30
|
| Hospital Charge Code |
1743537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
OP
|
$3.13
|
|
|
Service Code
|
NDC 0168-0277-40
|
| Hospital Charge Code |
1749025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.66
|
| Rate for Payer: Dignity Health Senior |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.66
|
| Rate for Payer: Vantage Medical Group Senior |
$2.66
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
IP
|
$3.13
|
|
|
Service Code
|
NDC 0168-0277-40
|
| Hospital Charge Code |
1749025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.15
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.35
|
|
|
CLINDAMYCIN 600 MG/50 ML D5W PHARMACY COMPOUND [4080739]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1722034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 600 MG/50 ML D5W PHARMACY COMPOUND [4080739]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1722034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1753488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1753488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
IP
|
$0.50
|
|
|
Service Code
|
NDC 59762-0016-1
|
| Hospital Charge Code |
1715008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
OP
|
$0.50
|
|
|
Service Code
|
NDC 59762-0016-1
|
| Hospital Charge Code |
1715008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Senior |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 64980-511-10
|
| Hospital Charge Code |
1715008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
IP
|
$0.56
|
|
|
Service Code
|
NDC 65862-596-01
|
| Hospital Charge Code |
1715008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
|
