|
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 |
$3.77 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$10.06
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Central Health Plan Commercial |
$15.07
|
| 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: Health Management Network EPO/PPO |
$16.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.13
|
| 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 |
$3.77 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.44
|
| 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 Exchange |
$9.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.13
|
| Rate for Payer: BCBS Transplant Transplant |
$11.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Central Health Plan Commercial |
$15.07
|
| 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: 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 Management Network EPO/PPO |
$16.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.13
|
| Rate for Payer: IEHP medi-cal |
$6.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.13
|
| 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: Riverside University Health MISP |
$7.54
|
| 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 Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$3.77 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.44
|
| 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 Exchange |
$9.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.13
|
| Rate for Payer: BCBS Transplant Transplant |
$11.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Central Health Plan Commercial |
$15.07
|
| 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: 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 Management Network EPO/PPO |
$16.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.13
|
| Rate for Payer: IEHP medi-cal |
$6.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.13
|
| 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: Riverside University Health MISP |
$7.54
|
| 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 Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.01
|
|
|
Canthoplasty (reconstruction of canthus)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Canthotomy (separate procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 67715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
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 |
$46.24 |
| Max. Negotiated Rate |
$208.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140.40
|
| 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 Exchange |
$111.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.58
|
| Rate for Payer: BCBS Transplant Transplant |
$138.71
|
| Rate for Payer: Blue Shield of California Commercial |
$145.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.05
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Central Health Plan Commercial |
$184.94
|
| 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: 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 Management Network EPO/PPO |
$208.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$173.38
|
| Rate for Payer: IEHP medi-cal |
$80.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.24
|
| Rate for Payer: Multiplan Commercial |
$173.38
|
| 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: Riverside University Health MISP |
$92.47
|
| 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 Medi-Cal |
$196.50
|
| Rate for Payer: Vantage Medical Group Senior |
$196.50
|
|
|
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 |
$46.24 |
| Max. Negotiated Rate |
$208.06 |
| Rate for Payer: Blue Shield of California Commercial |
$173.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.45
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Central Health Plan Commercial |
$184.94
|
| 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: Health Management Network EPO/PPO |
$208.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.24
|
| Rate for Payer: Multiplan Commercial |
$173.38
|
| Rate for Payer: Networks By Design Commercial |
$150.27
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$46.24 |
| Max. Negotiated Rate |
$208.06 |
| Rate for Payer: Blue Shield of California Commercial |
$173.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.45
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Central Health Plan Commercial |
$184.94
|
| 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: Health Management Network EPO/PPO |
$208.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.24
|
| Rate for Payer: Multiplan Commercial |
$173.38
|
| Rate for Payer: Networks By Design Commercial |
$150.27
|
| Rate for Payer: Prime Health Services Commercial |
$196.50
|
|
|
CAPMATINIB 200 MG TABLET [228061]
|
Facility
OP
|
$231.18
|
|
|
Service Code
|
NDC 0078-0716-56
|
| Hospital Charge Code |
ERX228061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$208.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140.40
|
| 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 Exchange |
$111.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.58
|
| Rate for Payer: BCBS Transplant Transplant |
$138.71
|
| Rate for Payer: Blue Shield of California Commercial |
$145.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.05
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Central Health Plan Commercial |
$184.94
|
| 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: 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 Management Network EPO/PPO |
$208.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$173.38
|
| Rate for Payer: IEHP medi-cal |
$80.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.24
|
| Rate for Payer: Multiplan Commercial |
$173.38
|
| 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: Riverside University Health MISP |
$92.47
|
| 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 Medi-Cal |
$196.50
|
| Rate for Payer: Vantage Medical Group Senior |
$196.50
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM [1350]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
1743536
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| 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 |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM [1350]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
1743536
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
CAPSAICIN 0.075 % TOPICAL CREAM [9399]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 0536-1118-25
|
| Hospital Charge Code |
NDG9399A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CAPSAICIN 0.075 % TOPICAL CREAM [9399]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 0536-1118-25
|
| Hospital Charge Code |
NDG9399A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| 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
|
|
|
Capsulectomy or capsulotomy; interphalangeal joint, each joint
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 26520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Capsulodesis, metacarpophalangeal joint; single digit
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 25320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 28270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
NDC 60687-304-21
|
| Hospital Charge Code |
1711381
|
|
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
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
NDC 60687-304-21
|
| Hospital Charge Code |
1711381
|
|
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
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
IP
|
$1.22
|
|
|
Service Code
|
NDC 0143-1171-01
|
| Hospital Charge Code |
1711381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
NDC 60687-304-11
|
| Hospital Charge Code |
1711381
|
|
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
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
NDC 60687-304-11
|
| Hospital Charge Code |
1711381
|
|
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
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 69292-522-01
|
| Hospital Charge Code |
1711381
|
|
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
|
|
|
CAPTOPRIL 12.5 MG TABLET [9401]
|
Facility
OP
|
$1.22
|
|
|
Service Code
|
NDC 0143-1171-01
|
| Hospital Charge Code |
1711381
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.92
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: Riverside University Health MISP |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
