LORAZEPAM 1 MG TABLET [4573]
|
Facility
OP
|
$0.10
|
|
Service Code
|
NDC 69315-905-01
|
Hospital Charge Code |
1730014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: BCBS Transplant Transplant |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
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: 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
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
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
|
|
LORAZEPAM 1 MG TABLET [4573]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 0904-6008-61
|
Hospital Charge Code |
1730014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
Rate for Payer: BCBS Transplant Transplant |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
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 |
$0.09
|
Rate for Payer: Dignity Health Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
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: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
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 |
$0.09
|
|
LORAZEPAM 1 MG TABLET [4573]
|
Facility
IP
|
$0.11
|
|
Service Code
|
NDC 0904-6008-61
|
Hospital Charge Code |
1730014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
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: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
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: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
LORAZEPAM 1 MG TABLET [4573]
|
Facility
IP
|
$0.17
|
|
Service Code
|
NDC 60687-638-01
|
Hospital Charge Code |
1730014
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]
|
Facility
IP
|
$1.55
|
|
Service Code
|
CPT J2060
|
Hospital Charge Code |
1720439
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.37 |
Max. Negotiated Rate |
$1.32 |
Rate for Payer: Blue Shield of California Commercial |
$1.10
|
Rate for Payer: Blue Shield of California EPN |
$0.79
|
Rate for Payer: Cash Price |
$0.70
|
Rate for Payer: Cigna of CA HMO |
$1.08
|
Rate for Payer: Cigna of CA PPO |
$1.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
Rate for Payer: Galaxy Health WC |
$1.32
|
Rate for Payer: Global Benefits Group Commercial |
$0.93
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: Multiplan Commercial |
$1.24
|
Rate for Payer: Networks By Design Commercial |
$0.78
|
Rate for Payer: Prime Health Services Commercial |
$1.32
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]
|
Facility
OP
|
$1.55
|
|
Service Code
|
CPT J2060
|
Hospital Charge Code |
1720439
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.37 |
Max. Negotiated Rate |
$23.76 |
Rate for Payer: Galaxy Health WC |
$1.32
|
Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.32
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.85
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.85
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
Rate for Payer: BCBS Transplant Transplant |
$0.93
|
Rate for Payer: Blue Shield of California Commercial |
$1.14
|
Rate for Payer: Blue Shield of California EPN |
$1.27
|
Rate for Payer: Cash Price |
$0.70
|
Rate for Payer: Cash Price |
$0.70
|
Rate for Payer: Cigna of CA HMO |
$1.08
|
Rate for Payer: Cigna of CA PPO |
$1.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.32
|
Rate for Payer: Dignity Health Media |
$1.32
|
Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
Rate for Payer: Global Benefits Group Commercial |
$0.93
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.60
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: Multiplan Commercial |
$1.24
|
Rate for Payer: Networks By Design Commercial |
$0.78
|
Rate for Payer: Prime Health Services Commercial |
$1.32
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
Rate for Payer: United Healthcare All Other HMO |
$0.78
|
Rate for Payer: United Healthcare HMO Rider |
$0.78
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
Rate for Payer: Vantage Medical Group Senior |
$1.32
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE [114210]
|
Facility
IP
|
$4.31
|
|
Service Code
|
CPT J2060
|
Hospital Charge Code |
NDG114210
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.03 |
Max. Negotiated Rate |
$3.66 |
Rate for Payer: Blue Shield of California Commercial |
$3.07
|
Rate for Payer: Blue Shield of California EPN |
$2.21
|
Rate for Payer: Cash Price |
$1.94
|
Rate for Payer: Cigna of CA HMO |
$3.02
|
Rate for Payer: Cigna of CA PPO |
$3.02
|
Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
Rate for Payer: EPIC Health Plan Transplant |
$1.72
|
Rate for Payer: Galaxy Health WC |
$3.66
|
Rate for Payer: Global Benefits Group Commercial |
$2.59
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
Rate for Payer: Multiplan Commercial |
$3.45
|
Rate for Payer: Networks By Design Commercial |
$2.16
|
Rate for Payer: Prime Health Services Commercial |
$3.66
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE [114210]
|
Facility
OP
|
$4.31
|
|
Service Code
|
CPT J2060
|
Hospital Charge Code |
NDG114210
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.03 |
Max. Negotiated Rate |
$23.76 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.37
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.37
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
Rate for Payer: BCBS Transplant Transplant |
$2.59
|
Rate for Payer: Blue Shield of California Commercial |
$3.18
|
Rate for Payer: Blue Shield of California EPN |
$1.27
|
Rate for Payer: Cash Price |
$1.94
|
Rate for Payer: Cash Price |
$1.94
|
Rate for Payer: Cigna of CA HMO |
$3.02
|
Rate for Payer: Cigna of CA PPO |
$3.02
|
Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
Rate for Payer: Dignity Health Media |
$3.66
|
Rate for Payer: Dignity Health Medi-Cal |
$3.66
|
Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
Rate for Payer: EPIC Health Plan Transplant |
$1.72
|
Rate for Payer: Galaxy Health WC |
$3.66
|
Rate for Payer: Global Benefits Group Commercial |
$2.59
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.60
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
Rate for Payer: Multiplan Commercial |
$3.45
|
Rate for Payer: Networks By Design Commercial |
$2.16
|
Rate for Payer: Prime Health Services Commercial |
$3.66
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
Rate for Payer: United Healthcare All Other HMO |
$2.16
|
Rate for Payer: United Healthcare HMO Rider |
$2.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.66
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3.66
|
Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]
|
Facility
IP
|
$1.26
|
|
Service Code
|
NDC 0054-3532-44
|
Hospital Charge Code |
1715191
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$1.07 |
Rate for Payer: Blue Shield of California Commercial |
$0.90
|
Rate for Payer: Blue Shield of California EPN |
$0.65
|
Rate for Payer: Cash Price |
$0.57
|
Rate for Payer: Cigna of CA HMO |
$0.88
|
Rate for Payer: Cigna of CA PPO |
$0.88
|
Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
Rate for Payer: Galaxy Health WC |
$1.07
|
Rate for Payer: Global Benefits Group Commercial |
$0.76
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
Rate for Payer: Multiplan Commercial |
$1.01
|
Rate for Payer: Networks By Design Commercial |
$0.82
|
Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]
|
Facility
OP
|
$1.26
|
|
Service Code
|
NDC 0054-3532-44
|
Hospital Charge Code |
1715191
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$1.07 |
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
Rate for Payer: Vantage Medical Group Senior |
$1.07
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
Rate for Payer: BCBS Transplant Transplant |
$0.76
|
Rate for Payer: Blue Shield of California Commercial |
$0.93
|
Rate for Payer: Blue Shield of California EPN |
$0.74
|
Rate for Payer: Cash Price |
$0.57
|
Rate for Payer: Cigna of CA HMO |
$0.88
|
Rate for Payer: Cigna of CA PPO |
$0.88
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
Rate for Payer: Dignity Health Media |
$1.07
|
Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
Rate for Payer: Galaxy Health WC |
$1.07
|
Rate for Payer: Global Benefits Group Commercial |
$0.76
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
Rate for Payer: Multiplan Commercial |
$1.01
|
Rate for Payer: Networks By Design Commercial |
$0.82
|
Rate for Payer: Prime Health Services Commercial |
$1.07
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.76
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
Rate for Payer: United Healthcare All Other HMO |
$0.63
|
Rate for Payer: United Healthcare HMO Rider |
$0.63
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]
|
Facility
OP
|
$0.60
|
|
Service Code
|
NDC 0121-0770-01
|
Hospital Charge Code |
1715191
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
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
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]
|
Facility
IP
|
$0.60
|
|
Service Code
|
NDC 0121-0770-01
|
Hospital Charge Code |
1715191
|
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
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.62
|
|
Service Code
|
NDC 68084-346-01
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.46
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.28
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
Rate for Payer: Dignity Health Media |
$0.53
|
Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
Rate for Payer: Galaxy Health WC |
$0.53
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.50
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.53
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.41
|
|
Service Code
|
NDC 50268-504-15
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
Rate for Payer: BCBS Transplant Transplant |
$0.25
|
Rate for Payer: Blue Shield of California Commercial |
$0.30
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
Rate for Payer: Dignity Health Media |
$0.35
|
Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.35
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.33
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.35
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
Rate for Payer: United Healthcare All Other HMO |
$0.21
|
Rate for Payer: United Healthcare HMO Rider |
$0.21
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.62
|
|
Service Code
|
NDC 68084-346-11
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.46
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.28
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
Rate for Payer: Dignity Health Media |
$0.53
|
Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
Rate for Payer: Galaxy Health WC |
$0.53
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.50
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.53
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 68382-135-16
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.62
|
|
Service Code
|
NDC 68084-346-01
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Blue Shield of California Commercial |
$0.44
|
Rate for Payer: Blue Shield of California EPN |
$0.32
|
Rate for Payer: Cash Price |
$0.28
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
Rate for Payer: Galaxy Health WC |
$0.53
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.50
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.50
|
|
Service Code
|
NDC 62332-027-90
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
Rate for Payer: BCBS Transplant Transplant |
$0.30
|
Rate for Payer: Blue Shield of California Commercial |
$0.37
|
Rate for Payer: Blue Shield of California EPN |
$0.29
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO |
$0.35
|
Rate for Payer: Cigna of CA PPO |
$0.35
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
Rate for Payer: Dignity Health Media |
$0.43
|
Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.43
|
Rate for Payer: Global Benefits Group Commercial |
$0.30
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.38
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.43
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.30
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.30
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.30
|
Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
Rate for Payer: United Healthcare All Other HMO |
$0.25
|
Rate for Payer: United Healthcare HMO Rider |
$0.25
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.41
|
|
Service Code
|
NDC 50268-504-15
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.21
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.35
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.33
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.50
|
|
Service Code
|
NDC 29300-144-19
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO |
$0.35
|
Rate for Payer: Cigna of CA PPO |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.43
|
Rate for Payer: Global Benefits Group Commercial |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 31722-700-90
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.09
|
|
Service Code
|
NDC 65862-201-90
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
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: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.08
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
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
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.50
|
|
Service Code
|
NDC 62332-027-90
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO |
$0.35
|
Rate for Payer: Cigna of CA PPO |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.43
|
Rate for Payer: Global Benefits Group Commercial |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
IP
|
$0.41
|
|
Service Code
|
NDC 50268-504-11
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.21
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.35
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.33
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
LOSARTAN 25 MG TABLET [14823]
|
Facility
OP
|
$0.09
|
|
Service Code
|
NDC 65862-201-90
|
Hospital Charge Code |
1711644
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Galaxy Health WC |
$0.08
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
Rate for Payer: BCBS Transplant Transplant |
$0.05
|
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 |
$0.04
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Media |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
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
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
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 |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|