|
CLONIDINE HCL 0.3 MG TABLET [1757]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0228-2129-10
|
| Hospital Charge Code |
1711466
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| 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 |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR [107665]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
NDC 27241-108-06
|
| Hospital Charge Code |
ERX107665
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR [107665]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
NDC 27241-108-06
|
| Hospital Charge Code |
ERX107665
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: Riverside University Health MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
CLONIDINE ORAL SUSPENSION COMPOUND 20 MCG/ML [4080258]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 9994-0802-58
|
| Hospital Charge Code |
1715208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
CLONIDINE ORAL SUSPENSION COMPOUND 20 MCG/ML [4080258]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 9994-0802-58
|
| Hospital Charge Code |
1715208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$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: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
CLONIDINE (PF) 5,000 MCG/10 ML EPIDURAL SOLUTION [27113]
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT J0735
|
| Hospital Charge Code |
NDG27113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.91
|
| Rate for Payer: BCBS Transplant Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$34.93
|
| Rate for Payer: Blue Shield of California EPN |
$31.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$14.70
|
| Rate for Payer: Cigna of CA PPO |
$14.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.75
|
| Rate for Payer: IEHP medi-cal |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Riverside University Health MISP |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
CLONIDINE (PF) 5,000 MCG/10 ML EPIDURAL SOLUTION [27113]
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT J0735
|
| Hospital Charge Code |
NDG27113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$14.70
|
| Rate for Payer: Cigna of CA PPO |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
IP
|
$11.52
|
|
|
Service Code
|
NDC 68084-752-19
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Blue Shield of California Commercial |
$8.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Central Health Plan Commercial |
$9.22
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
IP
|
$11.49
|
|
|
Service Code
|
NDC 50268-184-12
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Blue Shield of California Commercial |
$8.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.19
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
OP
|
$11.49
|
|
|
Service Code
|
NDC 50268-184-12
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.79
|
| Rate for Payer: BCBS Transplant Transplant |
$6.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.62
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.19
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.62
|
| Rate for Payer: IEHP medi-cal |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.89
|
| Rate for Payer: Riverside University Health MISP |
$4.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
OP
|
$15.94
|
|
|
Service Code
|
NDC 0904-6467-07
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$14.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.42
|
| Rate for Payer: BCBS Transplant Transplant |
$9.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.79
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$12.75
|
| Rate for Payer: Cigna of CA HMO |
$11.16
|
| Rate for Payer: Cigna of CA PPO |
$11.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.38
|
| Rate for Payer: Galaxy Health WC |
$13.55
|
| Rate for Payer: Global Benefits Group Commercial |
$9.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.96
|
| Rate for Payer: IEHP medi-cal |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$11.96
|
| Rate for Payer: Networks By Design Commercial |
$10.36
|
| Rate for Payer: Prime Health Services Commercial |
$13.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.56
|
| Rate for Payer: Riverside University Health MISP |
$6.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.97
|
| Rate for Payer: United Healthcare HMO Rider |
$7.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
IP
|
$11.49
|
|
|
Service Code
|
NDC 50268-184-11
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Blue Shield of California Commercial |
$8.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.19
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
IP
|
$15.94
|
|
|
Service Code
|
NDC 0904-6467-07
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$14.35 |
| Rate for Payer: Blue Shield of California Commercial |
$11.96
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$12.75
|
| Rate for Payer: Cigna of CA HMO |
$11.16
|
| Rate for Payer: Cigna of CA PPO |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.38
|
| Rate for Payer: Galaxy Health WC |
$13.55
|
| Rate for Payer: Global Benefits Group Commercial |
$9.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$11.96
|
| Rate for Payer: Networks By Design Commercial |
$10.36
|
| Rate for Payer: Prime Health Services Commercial |
$13.55
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
OP
|
$11.52
|
|
|
Service Code
|
NDC 68084-752-19
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.81
|
| Rate for Payer: BCBS Transplant Transplant |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7.25
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Central Health Plan Commercial |
$9.22
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.64
|
| Rate for Payer: IEHP medi-cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: Riverside University Health MISP |
$4.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.79
|
|
|
CLOPIDOGREL 300 MG TABLET [89346]
|
Facility
OP
|
$11.49
|
|
|
Service Code
|
NDC 50268-184-11
|
| Hospital Charge Code |
1711988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.79
|
| Rate for Payer: BCBS Transplant Transplant |
$6.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.62
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.19
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.62
|
| Rate for Payer: IEHP medi-cal |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.89
|
| Rate for Payer: Riverside University Health MISP |
$4.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 65862-357-30
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 55111-196-30
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 65862-357-30
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| 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 |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 55111-196-30
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| 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 |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
NDC 68084-536-11
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 68084-536-11
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 16729-218-10
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| 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: Central Health Plan Commercial |
$0.09
|
| 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: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| 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
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 0904-6294-61
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: IEHP medi-cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 68084-536-01
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
CLOPIDOGREL 75 MG TABLET [22142]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 0904-6294-61
|
| Hospital Charge Code |
1711725
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
