|
CHLORPROMAZINE 100 MG TABLET [1654]
|
Facility
OP
|
$14.98
|
|
|
Service Code
|
NDC 0904-6895-61
|
| Hospital Charge Code |
1710686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: BCBS Transplant Transplant |
$8.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.42
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Central Health Plan Commercial |
$11.98
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.24
|
| Rate for Payer: IEHP medi-cal |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.24
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: Riverside University Health MISP |
$5.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$12.73
|
|
|
CHLORPROMAZINE 100 MG TABLET [1654]
|
Facility
IP
|
$14.98
|
|
|
Service Code
|
NDC 0904-6895-61
|
| Hospital Charge Code |
1710686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Blue Shield of California Commercial |
$11.24
|
| Rate for Payer: Blue Shield of California EPN |
$8.00
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Central Health Plan Commercial |
$11.98
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.24
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| Hospital Charge Code |
1711161
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
OP
|
$19.86
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
1720458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$184.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.54
|
| Rate for Payer: BCBS Transplant Transplant |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$59.98
|
| Rate for Payer: Blue Shield of California EPN |
$54.53
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Central Health Plan Commercial |
$15.89
|
| Rate for Payer: Cigna of CA HMO |
$13.90
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$11.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.90
|
| Rate for Payer: IEHP medi-cal |
$30.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$16.88
|
| Rate for Payer: Riverside University Health MISP |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.88
|
| Rate for Payer: Vantage Medical Group Senior |
$16.88
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
IP
|
$19.86
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
1720458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.87 |
| Rate for Payer: Blue Shield of California Commercial |
$14.90
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Central Health Plan Commercial |
$15.89
|
| Rate for Payer: Cigna of CA HMO |
$13.90
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$11.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$16.88
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: IEHP medi-cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: Riverside University Health MISP |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
NDC 0527-2962-37
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$4.54
|
|
|
Service Code
|
NDC 0832-0301-00
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Central Health Plan Commercial |
$3.63
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$3.86
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.20
|
| Rate for Payer: BCBS Transplant Transplant |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.33
|
| Rate for Payer: IEHP medi-cal |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: Riverside University Health MISP |
$2.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-01
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$4.54
|
|
|
Service Code
|
NDC 0832-0301-00
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: BCBS Transplant Transplant |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Central Health Plan Commercial |
$3.63
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.40
|
| Rate for Payer: IEHP medi-cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$3.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.72
|
| Rate for Payer: Riverside University Health MISP |
$1.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: Vantage Medical Group Senior |
$3.86
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-11
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.20
|
| Rate for Payer: BCBS Transplant Transplant |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.33
|
| Rate for Payer: IEHP medi-cal |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: Riverside University Health MISP |
$2.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 0527-2962-37
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: Riverside University Health MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
IP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-11
|
| Hospital Charge Code |
1711171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$4.98
|
| Rate for Payer: Cigna of CA PPO |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.84
|
| Rate for Payer: Galaxy Health WC |
$6.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$6.04
|
|
|
CHLORPROMAZINE 50 MG TABLET [1657]
|
Facility
IP
|
$6.46
|
|
|
Service Code
|
NDC 0832-0302-00
|
| Hospital Charge Code |
1710664
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Central Health Plan Commercial |
$5.17
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
|
|
CHLORPROMAZINE 50 MG TABLET [1657]
|
Facility
OP
|
$6.46
|
|
|
Service Code
|
NDC 0832-0302-00
|
| Hospital Charge Code |
1710664
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.82
|
| Rate for Payer: BCBS Transplant Transplant |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Central Health Plan Commercial |
$5.17
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.84
|
| Rate for Payer: IEHP medi-cal |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.88
|
| Rate for Payer: Riverside University Health MISP |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.23
|
| Rate for Payer: United Healthcare All Other HMO |
$3.23
|
| Rate for Payer: United Healthcare HMO Rider |
$3.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5.49
|
|
|
CHLORTHALIDONE 25 MG TABLET [1661]
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
NDC 60687-317-25
|
| Hospital Charge Code |
1710179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.72
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
CHLORTHALIDONE 25 MG TABLET [1661]
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 60687-317-11
|
| Hospital Charge Code |
1710179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
CHLORTHALIDONE 25 MG TABLET [1661]
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
NDC 60687-317-95
|
| Hospital Charge Code |
1710179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.72
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
CHLORTHALIDONE 25 MG TABLET [1661]
|
Facility
OP
|
$2.70
|
|
|
Service Code
|
NDC 60687-317-11
|
| Hospital Charge Code |
1710179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.02
|
| Rate for Payer: IEHP medi-cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: Riverside University Health MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
CHLORTHALIDONE 25 MG TABLET [1661]
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
NDC 51079-058-01
|
| Hospital Charge Code |
1710179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.72
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
