|
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 |
$9.69 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| 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: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.12
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Senior |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.26
|
| 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 |
$25.53
|
| 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: 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: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$3.01 |
| Max. Negotiated Rate |
$12.46 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.24
|
| Rate for Payer: Heritage Provider Network Senior |
$11.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
|
|
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 |
$9.69 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| 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: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.12
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Senior |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.26
|
| 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 |
$25.53
|
| 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: 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: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 0378-0872-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| 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: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.12
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Senior |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.26
|
| 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 |
$25.53
|
| 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: 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: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0591-3509-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.24
|
| Rate for Payer: Heritage Provider Network Senior |
$36.24
|
| 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 |
$40.15
|
|
|
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 |
$9.69 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| 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: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.12
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.50
|
| Rate for Payer: Dignity Health Senior |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.26
|
| 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 |
$25.53
|
| 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: 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: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.50
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
NDC 0378-0872-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.24
|
| Rate for Payer: Heritage Provider Network Senior |
$36.24
|
| 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 |
$40.15
|
|
|
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 |
$9.69 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.24
|
| Rate for Payer: Heritage Provider Network Senior |
$36.24
|
| 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 |
$40.15
|
|
|
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 |
$9.69 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.24
|
| Rate for Payer: Heritage Provider Network Senior |
$36.24
|
| 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 |
$40.15
|
|
|
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 |
$3.01 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.41
|
| 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: Blue Shield of California Commercial |
$10.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.11
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.12
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.28
|
| Rate for Payer: Heritage Provider Network Senior |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| 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: TriValley Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.12
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: Adventist Health Commercial |
$14.85
|
| Rate for Payer: Cash Price |
$40.85
|
| 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
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 |
$9.29
|
| Rate for Payer: Multiplan Commercial |
$27.89
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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 |
$45.30
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$40.85
|
| 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 |
$35.43
|
| 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: Molina Healthcare of CA Medi-Cal |
$51.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.99
|
| 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: United Healthcare All Other HMO/non HMO |
$37.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.13
|
| Rate for Payer: Vantage Medical Group Senior |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$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 |
$27.89
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$18.14
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.03
|
| Rate for Payer: Multiplan Commercial |
$27.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.87
|
| Rate for Payer: TriValley Medical Group Senior |
$14.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.60
|
| Rate for Payer: Vantage Medical Group Senior |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
OP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
901700029
|
|
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 |
$27.89
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$18.14
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.03
|
| Rate for Payer: Multiplan Commercial |
$27.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.87
|
| Rate for Payer: TriValley Medical Group Senior |
$14.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.60
|
| Rate for Payer: Vantage Medical Group Senior |
$31.60
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$74.27
|
|
|
Service Code
|
NDC 0591-3510-54
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$40.85
|
| 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 |
901700029
|
|
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 |
$45.30
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$40.85
|
| 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 |
$35.43
|
| 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: Molina Healthcare of CA Medi-Cal |
$51.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.99
|
| 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: United Healthcare All Other HMO/non HMO |
$37.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.13
|
| Rate for Payer: Vantage Medical Group Senior |
$63.13
|
|
|
CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]
|
Facility
|
IP
|
$37.18
|
|
|
Service Code
|
NDC 51862-455-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$7.44
|
| Rate for Payer: Cash Price |
$20.45
|
| 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 |
$9.29
|
| Rate for Payer: Multiplan Commercial |
$27.89
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 68001-237-00
|
| 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: Cash Price |
$0.03
|
| 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 62332-054-31
|
| 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: Cash Price |
$0.03
|
| 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 |
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 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| 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: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| 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
|
$0.36
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| 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 |
$0.27
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 60687-113-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1755]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 68001-237-00
|
| 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 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| 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: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| 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
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 60687-113-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
