|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-11
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-01
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: Blue Distinction Transplant |
$3.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Media |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-11
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: Blue Distinction Transplant |
$3.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Media |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-58
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-01
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-01
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-01
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: Blue Distinction Transplant |
$3.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Media |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: Blue Distinction Transplant |
$3.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Media |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-58
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [9924]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 64679-925-02
|
| Hospital Charge Code |
1711458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Distinction Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [9924]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 43547-547-10
|
| Hospital Charge Code |
1711458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [9924]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 43547-547-10
|
| Hospital Charge Code |
1711458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [9924]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 64679-925-02
|
| Hospital Charge Code |
1711458
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 52652-4001-1
|
| Hospital Charge Code |
1715986
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Distinction Transplant |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$3.30
|
| Rate for Payer: Cigna of CA PPO |
$3.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.01
|
| Rate for Payer: Dignity Health Media |
$4.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.01
|
| Rate for Payer: Vantage Medical Group Senior |
$4.01
|
|
|
ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION [216253]
|
Facility
|
IP
|
$4.72
|
|
|
Service Code
|
NDC 52652-4001-1
|
| Hospital Charge Code |
1715986
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Blue Shield of California Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$3.30
|
| Rate for Payer: Cigna of CA PPO |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.01
|
|
|
ENALAPRIL MALEATE 20 MG TABLET [9926]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 68682-713-01
|
| Hospital Charge Code |
1711459
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ENALAPRIL MALEATE 20 MG TABLET [9926]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 68084-392-11
|
| Hospital Charge Code |
1711459
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
ENALAPRIL MALEATE 20 MG TABLET [9926]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 68682-713-01
|
| Hospital Charge Code |
1711459
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
