|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 7288815301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CLONAZEPAM 1 MG TABLET [9638]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 5026817415
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.36
|
| 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 Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
|
|
CLONAZEPAM 2 MG TABLET [9639]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 1672913800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CLONAZEPAM 2 MG TABLET [9639]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 1672913800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
NDC 5186245304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.84
|
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.77
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.85
|
| Rate for Payer: Heritage Provider Network Senior |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.37
|
| Rate for Payer: TriValley Medical Group Senior |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.53
|
| Rate for Payer: Vantage Medical Group Senior |
$13.53
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
NDC 5186245301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.77
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.85
|
| Rate for Payer: Heritage Provider Network Senior |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.37
|
| Rate for Payer: TriValley Medical Group Senior |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.53
|
| Rate for Payer: Vantage Medical Group Senior |
$13.53
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
NDC 5186245304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.25
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
|
|
CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
NDC 5186245301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.25
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
|
|
CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
IP
|
$16.61
|
|
|
Service Code
|
NDC 5281761104
|
| 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: Aetna of CA Non-Gatekeeper |
$10.70
|
| Rate for Payer: Cash Price |
$7.47
|
| 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 Foundation Hospitals 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
|
IP
|
$53.54
|
|
|
Service Code
|
NDC 0591350954
|
| Hospital Charge Code |
901700029
|
|
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 |
$34.48
|
| 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 Foundation Hospitals 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 0378087299
|
| Hospital Charge Code |
901700029
|
|
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 |
$34.48
|
| 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 Foundation Hospitals 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
|
$16.61
|
|
|
Service Code
|
NDC 5281761104
|
| 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 Non-Gatekeeper |
$10.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.31
|
| 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 |
$7.47
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]
|
Facility
|
OP
|
$53.54
|
|
|
Service Code
|
NDC 0591350954
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$33.09
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$26.78
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| Rate for Payer: Blue Shield of California EPN |
$26.13
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.48
|
| 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: 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 |
$45.51
|
| 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 0378087216
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$33.09
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$26.78
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| Rate for Payer: Blue Shield of California EPN |
$26.13
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.48
|
| 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: 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 |
$45.51
|
| 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
|
$53.54
|
|
|
Service Code
|
NDC 0378087216
|
| Hospital Charge Code |
901700029
|
|
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 |
$34.48
|
| 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 Foundation Hospitals 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 0591350904
|
| Hospital Charge Code |
901700029
|
|
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 |
$34.48
|
| 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 Foundation Hospitals 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 0378087299
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$33.09
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$26.78
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| Rate for Payer: Blue Shield of California EPN |
$26.13
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.48
|
| 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: 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 |
$45.51
|
| 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 0591350904
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$33.09
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$26.78
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| Rate for Payer: Blue Shield of California EPN |
$26.13
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.48
|
| 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: 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 |
$45.51
|
| 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
|
$74.27
|
|
|
Service Code
|
NDC 0591351054
|
| 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 Non-Gatekeeper |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.15
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$35.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$74.27
|
|
|
Service Code
|
NDC 0591351004
|
| 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: Aetna of CA Non-Gatekeeper |
$47.83
|
| 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 Foundation Hospitals 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 0591351054
|
| 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: Aetna of CA Non-Gatekeeper |
$47.83
|
| 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 Foundation Hospitals 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 0591351004
|
| 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 Non-Gatekeeper |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.15
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$35.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 HCL 0.1 MG TABLET [1755]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 6800123703
|
| 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 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: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$0.05
|
|
|
Service Code
|
NDC 6233205431
|
| 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 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 Foundation Hospitals 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
|
$0.43
|
|
|
Service Code
|
NDC 0904744261
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
