|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0024-5150-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0024-5150-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
CANAGLIFLOZIN 100 MG TABLET [201798]
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 50458-140-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California Commercial |
$17.67
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$19.15
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
|
|
CANAGLIFLOZIN 100 MG TABLET [201798]
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 50458-140-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.70
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.76
|
| Rate for Payer: Multiplan Commercial |
$19.15
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 49884-661-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
NDC 0378-3232-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
NDC 33342-117-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 49884-661-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
NDC 33342-117-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
NDC 0378-3232-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
|
|
CANDESARTAN 8 MG TABLET [23230]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 0378-3225-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
CANDESARTAN 8 MG TABLET [23230]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 0378-3225-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
OP
|
$20.52
|
|
|
Service Code
|
NDC 70127-100-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$13.34
|
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.60
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: EPIC Health Plan Senior |
$8.21
|
| Rate for Payer: Galaxy Health WC |
$17.44
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.36
|
| Rate for Payer: Prime Health Services Commercial |
$17.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.26
|
| Rate for Payer: United Healthcare HMO Rider |
$10.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.44
|
| Rate for Payer: Vantage Medical Group Senior |
$17.44
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
IP
|
$20.52
|
|
|
Service Code
|
NDC 70127-100-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.14
|
| Rate for Payer: Blue Shield of California EPN |
$9.97
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: EPIC Health Plan Senior |
$8.21
|
| Rate for Payer: Galaxy Health WC |
$17.44
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$17.44
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
IP
|
$20.52
|
|
|
Service Code
|
NDC 70127-100-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.14
|
| Rate for Payer: Blue Shield of California EPN |
$9.97
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: EPIC Health Plan Senior |
$8.21
|
| Rate for Payer: Galaxy Health WC |
$17.44
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$17.44
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
OP
|
$20.52
|
|
|
Service Code
|
NDC 70127-100-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.60
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: EPIC Health Plan Senior |
$8.21
|
| Rate for Payer: Galaxy Health WC |
$17.44
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$17.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.26
|
| Rate for Payer: United Healthcare HMO Rider |
$10.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.44
|
| Rate for Payer: Vantage Medical Group Senior |
$17.44
|
|
|
CAPMATINIB 150 MG TABLET [228060]
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
NDC 0078-0709-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
CAPMATINIB 150 MG TABLET [228060]
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
NDC 0078-0709-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.53
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
CAPMATINIB 200 MG TABLET [228061]
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
NDC 0078-0716-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
CAPMATINIB 200 MG TABLET [228061]
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
NDC 0078-0716-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.53
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM [1350]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM [1350]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CAPSAICIN 0.075 % TOPICAL CREAM [9399]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0536-1118-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
CAPSAICIN 0.075 % TOPICAL CREAM [9399]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0536-1118-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CAPSAICIN 0.1 % TOPICAL CREAM [70403]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6056944302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
