|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 3700054406
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 3700054401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 2390000361
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT [76967]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 2390003920
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4612257310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 4612257310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0024515006
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0024515005
|
| 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 |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0024515006
|
| 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 |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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 0024515005
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 5045814030
|
| 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 |
$15.36
|
| Rate for Payer: Cash Price |
$10.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| 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
|
|
|
CANAGLIFLOZIN 100 MG TABLET [201798]
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 5045814030
|
| 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 |
$12.14
|
| Rate for Payer: Blue Shield of California Commercial |
$18.41
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| 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
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
NDC 3334211707
|
| 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 |
$1.31
|
| Rate for Payer: Cash Price |
$0.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| 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
|
IP
|
$2.04
|
|
|
Service Code
|
NDC 3334211707
|
| 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 |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| 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 0378323293
|
| 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 |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| 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
|
OP
|
$2.04
|
|
|
Service Code
|
NDC 0378323293
|
| 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 |
$1.31
|
| Rate for Payer: Cash Price |
$0.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| 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 8 MG TABLET [23230]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 0378322593
|
| 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 |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| 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 0378322593
|
| 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 |
$1.03
|
| Rate for Payer: Cash Price |
$0.72
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| 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
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]
|
Facility
|
IP
|
$1,260.31
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$252.06 |
| Max. Negotiated Rate |
$1,071.26 |
| Rate for Payer: Adventist Health Commercial |
$252.06
|
| Rate for Payer: Blue Shield of California Commercial |
$638.98
|
| Rate for Payer: Blue Shield of California Commercial |
$969.18
|
| Rate for Payer: Cash Price |
$567.14
|
| Rate for Payer: Cigna of CA HMO |
$882.22
|
| Rate for Payer: Cigna of CA PPO |
$882.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.12
|
| Rate for Payer: EPIC Health Plan Senior |
$504.12
|
| Rate for Payer: Galaxy Health WC |
$1,071.26
|
| Rate for Payer: Global Benefits Group Commercial |
$756.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.47
|
| Rate for Payer: Multiplan Commercial |
$1,008.25
|
| Rate for Payer: Networks By Design Commercial |
$630.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.99
|
| Rate for Payer: United Healthcare All Other HMO |
$460.39
|
| Rate for Payer: United Healthcare HMO Rider |
$450.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$412.75
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]
|
Facility
|
OP
|
$1,260.31
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$1,071.26 |
| Rate for Payer: Adventist Health Commercial |
$252.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.23
|
| Rate for Payer: Blue Shield of California Commercial |
$22.91
|
| Rate for Payer: Cash Price |
$567.14
|
| Rate for Payer: Cash Price |
$567.14
|
| Rate for Payer: Cigna of CA HMO |
$882.22
|
| Rate for Payer: Cigna of CA PPO |
$882.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.31
|
| Rate for Payer: Galaxy Health WC |
$1,071.26
|
| Rate for Payer: Global Benefits Group Commercial |
$756.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$1,008.25
|
| Rate for Payer: Networks By Design Commercial |
$630.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.99
|
| Rate for Payer: United Healthcare All Other HMO |
$460.39
|
| Rate for Payer: United Healthcare HMO Rider |
$450.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$412.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$22.31
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
NDC 7012710010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.71
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna of CA HMO |
$14.95
|
| Rate for Payer: Cigna of CA PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Senior |
$8.54
|
| Rate for Payer: Galaxy Health WC |
$18.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: Networks By Design Commercial |
$13.88
|
| Rate for Payer: Prime Health Services Commercial |
$18.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.16
|
| Rate for Payer: Vantage Medical Group Senior |
$18.16
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
NDC 7012710010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.43
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna of CA HMO |
$14.95
|
| Rate for Payer: Cigna of CA PPO |
$14.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Senior |
$8.54
|
| Rate for Payer: Galaxy Health WC |
$18.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: Networks By Design Commercial |
$13.88
|
| Rate for Payer: Prime Health Services Commercial |
$18.16
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
NDC 7012710001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.71
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna of CA HMO |
$14.95
|
| Rate for Payer: Cigna of CA PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Senior |
$8.54
|
| Rate for Payer: Galaxy Health WC |
$18.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: Networks By Design Commercial |
$13.88
|
| Rate for Payer: Prime Health Services Commercial |
$18.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.16
|
| Rate for Payer: Vantage Medical Group Senior |
$18.16
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
NDC 7012710001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.43
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna of CA HMO |
$14.95
|
| Rate for Payer: Cigna of CA PPO |
$14.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Senior |
$8.54
|
| Rate for Payer: Galaxy Health WC |
$18.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: Networks By Design Commercial |
$13.88
|
| Rate for Payer: Prime Health Services Commercial |
$18.16
|
|
|
CAPMATINIB 150 MG TABLET [228060]
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
NDC 0078070956
|
| 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 |
$126.75
|
| Rate for Payer: Blue Shield of California Commercial |
$192.25
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| 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
|
|
