|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 0316-0229-75
|
| Hospital Charge Code |
1743717
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| 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-MENTHOL 0.5 %-0.5 % LOTION [23063]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 46122-573-10
|
| Hospital Charge Code |
1743717
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$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: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| 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 46122-573-10
|
| Hospital Charge Code |
1743717
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| 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-MENTHOL 0.5 %-0.5 % LOTION [23063]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 0316-0229-75
|
| Hospital Charge Code |
1743717
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0024-5150-05
|
| Hospital Charge Code |
NDG12562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| 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 Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: 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
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0024-5150-06
|
| Hospital Charge Code |
1743140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: 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 0024-5150-06
|
| Hospital Charge Code |
1743140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| 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 Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: 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
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CAMPHOR-PHENOL 10.8 %-4.7 % TOPICAL SOLUTION [12562]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0024-5150-05
|
| Hospital Charge Code |
NDG12562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
CANAGLIFLOZIN 100 MG TABLET [201798]
|
Facility
IP
|
$23.94
|
|
|
Service Code
|
NDC 50458-140-30
|
| Hospital Charge Code |
ERX201798
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Blue Shield of California Commercial |
$17.05
|
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| 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: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$19.15
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
|
|
CANAGLIFLOZIN 100 MG TABLET [201798]
|
Facility
OP
|
$23.94
|
|
|
Service Code
|
NDC 50458-140-30
|
| Hospital Charge Code |
ERX201798
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$20.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.26
|
| Rate for Payer: BCBS Transplant Transplant |
$14.36
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.98
|
| 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 Media |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
IP
|
$3.82
|
|
|
Service Code
|
NDC 49884-661-09
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
IP
|
$2.04
|
|
|
Service Code
|
NDC 0378-3232-93
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| 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: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: 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 33342-117-07
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| 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: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: 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 33342-117-07
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.22
|
| Rate for Payer: BCBS Transplant Transplant |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| 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 Media |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
OP
|
$3.82
|
|
|
Service Code
|
NDC 49884-661-09
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.28
|
| Rate for Payer: BCBS Transplant Transplant |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Media |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
|
|
CANDESARTAN 32 MG TABLET [23232]
|
Facility
OP
|
$2.04
|
|
|
Service Code
|
NDC 0378-3232-93
|
| Hospital Charge Code |
1712295
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.22
|
| Rate for Payer: BCBS Transplant Transplant |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| 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 Media |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.22
|
| 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
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]
|
Facility
IP
|
$1,070.39
|
|
|
Service Code
|
CPT C9460
|
| Hospital Charge Code |
ERX210327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.89 |
| Max. Negotiated Rate |
$909.83 |
| Rate for Payer: Blue Shield of California Commercial |
$762.12
|
| Rate for Payer: Blue Shield of California EPN |
$548.04
|
| Rate for Payer: Cash Price |
$481.68
|
| Rate for Payer: Cigna of CA HMO |
$749.27
|
| Rate for Payer: Cigna of CA PPO |
$749.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$428.16
|
| Rate for Payer: Galaxy Health WC |
$909.83
|
| Rate for Payer: Global Benefits Group Commercial |
$642.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.89
|
| Rate for Payer: Multiplan Commercial |
$856.31
|
| Rate for Payer: Networks By Design Commercial |
$535.20
|
| Rate for Payer: Prime Health Services Commercial |
$909.83
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION [210327]
|
Facility
OP
|
$1,070.39
|
|
|
Service Code
|
CPT C9460
|
| Hospital Charge Code |
ERX210327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$909.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.89
|
| Rate for Payer: BCBS Transplant Transplant |
$642.23
|
| Rate for Payer: Blue Shield of California Commercial |
$788.88
|
| Rate for Payer: Blue Shield of California EPN |
$625.11
|
| Rate for Payer: Cash Price |
$481.68
|
| Rate for Payer: Cash Price |
$481.68
|
| Rate for Payer: Cigna of CA HMO |
$749.27
|
| Rate for Payer: Cigna of CA PPO |
$749.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.37
|
| Rate for Payer: Dignity Health Media |
$18.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$909.83
|
| Rate for Payer: Global Benefits Group Commercial |
$642.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$802.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.93
|
| Rate for Payer: IEHP Medi-Cal |
$29.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.56
|
| Rate for Payer: IEHP Medicare Advantage |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.45
|
| Rate for Payer: Multiplan Commercial |
$856.31
|
| Rate for Payer: Networks By Design Commercial |
$535.20
|
| Rate for Payer: Prime Health Services Commercial |
$909.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$642.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.20
|
| Rate for Payer: United Healthcare All Other HMO |
$535.20
|
| Rate for Payer: United Healthcare HMO Rider |
$535.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Vantage Medical Group Senior |
$18.25
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
IP
|
$18.84
|
|
|
Service Code
|
NDC 70127-100-10
|
| Hospital Charge Code |
NDG22792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Blue Shield of California Commercial |
$13.41
|
| Rate for Payer: Blue Shield of California EPN |
$9.65
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$13.19
|
| Rate for Payer: Cigna of CA PPO |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.52
|
| Rate for Payer: Multiplan Commercial |
$15.07
|
| Rate for Payer: Networks By Design Commercial |
$12.25
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
OP
|
$18.84
|
|
|
Service Code
|
NDC 70127-100-10
|
| Hospital Charge Code |
NDG22792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.22
|
| Rate for Payer: BCBS Transplant Transplant |
$11.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.89
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$13.19
|
| Rate for Payer: Cigna of CA PPO |
$13.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.01
|
| Rate for Payer: Dignity Health Media |
$16.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.52
|
| Rate for Payer: Multiplan Commercial |
$15.07
|
| Rate for Payer: Networks By Design Commercial |
$12.25
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.01
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
IP
|
$18.84
|
|
|
Service Code
|
NDC 70127-100-01
|
| Hospital Charge Code |
NDG22792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Blue Shield of California Commercial |
$13.41
|
| Rate for Payer: Blue Shield of California EPN |
$9.65
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$13.19
|
| Rate for Payer: Cigna of CA PPO |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.52
|
| Rate for Payer: Multiplan Commercial |
$15.07
|
| Rate for Payer: Networks By Design Commercial |
$12.25
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION [222792]
|
Facility
OP
|
$18.84
|
|
|
Service Code
|
NDC 70127-100-01
|
| Hospital Charge Code |
NDG22792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.22
|
| Rate for Payer: BCBS Transplant Transplant |
$11.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.89
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$13.19
|
| Rate for Payer: Cigna of CA PPO |
$13.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.01
|
| Rate for Payer: Dignity Health Media |
$16.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.52
|
| Rate for Payer: Multiplan Commercial |
$15.07
|
| Rate for Payer: Networks By Design Commercial |
$12.25
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.01
|
|
|
CAPMATINIB 150 MG TABLET [228060]
|
Facility
IP
|
$231.18
|
|
|
Service Code
|
NDC 0078-0709-56
|
| Hospital Charge Code |
ERX228060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Blue Shield of California Commercial |
$164.60
|
| Rate for Payer: Blue Shield of California EPN |
$118.36
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna of CA HMO |
$161.83
|
| Rate for Payer: Cigna of CA PPO |
$161.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.47
|
| Rate for Payer: Galaxy Health WC |
$196.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.48
|
| Rate for Payer: Multiplan Commercial |
$184.94
|
| Rate for Payer: Networks By Design Commercial |
$150.27
|
| Rate for Payer: Prime Health Services Commercial |
$196.50
|
|
|
CAPMATINIB 150 MG TABLET [228060]
|
Facility
OP
|
$231.18
|
|
|
Service Code
|
NDC 0078-0709-56
|
| Hospital Charge Code |
ERX228060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$151.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$196.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.74
|
| Rate for Payer: BCBS Transplant Transplant |
$138.71
|
| Rate for Payer: Blue Shield of California Commercial |
$170.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.01
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna of CA HMO |
$161.83
|
| Rate for Payer: Cigna of CA PPO |
$161.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.50
|
| Rate for Payer: Dignity Health Media |
$196.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.47
|
| Rate for Payer: Galaxy Health WC |
$196.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$173.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.48
|
| Rate for Payer: Multiplan Commercial |
$184.94
|
| Rate for Payer: Networks By Design Commercial |
$150.27
|
| Rate for Payer: Prime Health Services Commercial |
$196.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$138.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.59
|
| Rate for Payer: United Healthcare All Other HMO |
$115.59
|
| Rate for Payer: United Healthcare HMO Rider |
$115.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.50
|
| Rate for Payer: Vantage Medical Group Senior |
$196.50
|
|
|
CAPMATINIB 200 MG TABLET [228061]
|
Facility
IP
|
$231.18
|
|
|
Service Code
|
NDC 0078-0716-56
|
| Hospital Charge Code |
ERX228061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Blue Shield of California Commercial |
$164.60
|
| Rate for Payer: Blue Shield of California EPN |
$118.36
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna of CA HMO |
$161.83
|
| Rate for Payer: Cigna of CA PPO |
$161.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.47
|
| Rate for Payer: Galaxy Health WC |
$196.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.48
|
| Rate for Payer: Multiplan Commercial |
$184.94
|
| Rate for Payer: Networks By Design Commercial |
$150.27
|
| Rate for Payer: Prime Health Services Commercial |
$196.50
|
|
