|
CHLOROQUINE ORAL SUSPENSION COMPOUND 15 MG/ML [4080254]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0802-54
|
| Hospital Charge Code |
1715014
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
1715531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
1715531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
IP
|
$119.76
|
|
|
Service Code
|
CPT J1205
|
| Hospital Charge Code |
1720125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$101.80 |
| Rate for Payer: Blue Shield of California Commercial |
$85.27
|
| Rate for Payer: Blue Shield of California Commercial |
$254.35
|
| Rate for Payer: Blue Shield of California Commercial |
$41.60
|
| Rate for Payer: Blue Shield of California Commercial |
$136.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.26
|
| Rate for Payer: Blue Shield of California EPN |
$36.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.30
|
| Rate for Payer: Blue Shield of California EPN |
$182.91
|
| Rate for Payer: Blue Shield of California EPN |
$29.92
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$83.83
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$40.90
|
| Rate for Payer: Cigna of CA HMO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$40.90
|
| Rate for Payer: Cigna of CA PPO |
$83.83
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$303.65
|
| Rate for Payer: Galaxy Health WC |
$49.67
|
| Rate for Payer: Galaxy Health WC |
$101.80
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.86
|
| Rate for Payer: Global Benefits Group Commercial |
$214.34
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$35.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$285.79
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$95.81
|
| Rate for Payer: Networks By Design Commercial |
$178.62
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$59.88
|
| Rate for Payer: Prime Health Services Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$101.80
|
| Rate for Payer: Prime Health Services Commercial |
$303.65
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
OP
|
$119.76
|
|
|
Service Code
|
CPT J1205
|
| Hospital Charge Code |
1720125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$763.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$763.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$763.21
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$49.67
|
| Rate for Payer: Galaxy Health WC |
$303.65
|
| Rate for Payer: Galaxy Health WC |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$763.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$763.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$303.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$196.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.62
|
| Rate for Payer: BCBS Transplant Transplant |
$71.86
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: BCBS Transplant Transplant |
$115.20
|
| Rate for Payer: BCBS Transplant Transplant |
$35.06
|
| Rate for Payer: BCBS Transplant Transplant |
$214.34
|
| Rate for Payer: Blue Shield of California Commercial |
$88.26
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$263.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.06
|
| Rate for Payer: Blue Shield of California Commercial |
$141.50
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$250.07
|
| Rate for Payer: Cigna of CA HMO |
$83.83
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$40.90
|
| Rate for Payer: Cigna of CA PPO |
$40.90
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$83.83
|
| Rate for Payer: Cigna of CA PPO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.67
|
| Rate for Payer: Dignity Health Media |
$163.20
|
| Rate for Payer: Dignity Health Media |
$101.80
|
| Rate for Payer: Dignity Health Media |
$49.67
|
| Rate for Payer: Dignity Health Media |
$303.65
|
| Rate for Payer: Dignity Health Media |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$35.06
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.86
|
| Rate for Payer: Global Benefits Group Commercial |
$214.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$144.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$43.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$267.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.74
|
| Rate for Payer: Multiplan Commercial |
$95.81
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$285.79
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$178.62
|
| Rate for Payer: Networks By Design Commercial |
$59.88
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$303.65
|
| Rate for Payer: Prime Health Services Commercial |
$101.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.62
|
| Rate for Payer: United Healthcare All Other HMO |
$59.88
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO |
$178.62
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$59.88
|
| Rate for Payer: United Healthcare HMO Rider |
$178.62
|
| Rate for Payer: United Healthcare HMO Rider |
$96.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$303.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.67
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$49.67
|
| Rate for Payer: Vantage Medical Group Senior |
$101.80
|
| Rate for Payer: Vantage Medical Group Senior |
$303.65
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
CHLORPROMAZINE 100 MG TABLET [1654]
|
Facility
OP
|
$14.98
|
|
|
Service Code
|
NDC 0904-6895-61
|
| Hospital Charge Code |
1710686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.93
|
| Rate for Payer: BCBS Transplant Transplant |
$8.99
|
| Rate for Payer: Blue Shield of California Commercial |
$11.04
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.73
|
| Rate for Payer: Dignity Health Media |
$12.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$12.73
|
|
|
CHLORPROMAZINE 100 MG TABLET [1654]
|
Facility
IP
|
$14.98
|
|
|
Service Code
|
NDC 0904-6895-61
|
| Hospital Charge Code |
1710686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.67
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
OP
|
$19.86
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
1720458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$187.31 |
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO |
$13.90
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.24
|
| Rate for Payer: BCBS Transplant Transplant |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$54.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.88
|
| Rate for Payer: Dignity Health Media |
$16.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$11.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$15.89
|
| Rate for Payer: Networks By Design Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$16.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.88
|
| Rate for Payer: Vantage Medical Group Senior |
$16.88
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
IP
|
$19.86
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
1720458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Blue Shield of California Commercial |
$14.14
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO |
$13.90
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$15.89
|
| Rate for Payer: Networks By Design Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$16.88
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$4.54
|
|
|
Service Code
|
NDC 0832-0301-00
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.70
|
| Rate for Payer: BCBS Transplant Transplant |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.86
|
| Rate for Payer: Dignity Health Media |
$3.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$3.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: Vantage Medical Group Senior |
$3.86
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$4.54
|
|
|
Service Code
|
NDC 0832-0301-00
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$3.86
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Media |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 0527-2962-37
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-11
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.24
|
| Rate for Payer: BCBS Transplant Transplant |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.15
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.04
|
| Rate for Payer: Dignity Health Media |
$6.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-11
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: BCBS Transplant Transplant |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.15
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.04
|
| Rate for Payer: Dignity Health Media |
$6.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
NDC 0527-2962-37
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
CHLORPROMAZINE 50 MG TABLET [1657]
|
Facility
OP
|
$6.46
|
|
|
Service Code
|
NDC 0832-0302-00
|
| Hospital Charge Code |
1710664
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: BCBS Transplant Transplant |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.49
|
| Rate for Payer: Dignity Health Media |
$5.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$5.17
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.23
|
| Rate for Payer: United Healthcare All Other HMO |
$3.23
|
| Rate for Payer: United Healthcare HMO Rider |
$3.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5.49
|
|
|
CHLORPROMAZINE 50 MG TABLET [1657]
|
Facility
IP
|
$6.46
|
|
|
Service Code
|
NDC 0832-0302-00
|
| Hospital Charge Code |
1710664
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Blue Shield of California Commercial |
$4.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.31
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$5.17
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
|
