|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
NDG4080770B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.02
|
| Rate for Payer: Dignity Health Senior |
$4.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: Vantage Medical Group Senior |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$35.74
|
|
|
Service Code
|
NDC 98193-000-17
|
| Hospital Charge Code |
NDG4080770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.19
|
| Rate for Payer: Blue Shield of California EPN |
$20.98
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.38
|
| Rate for Payer: Dignity Health Senior |
$30.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.12
|
| Rate for Payer: Heritage Provider Network Senior |
$22.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.38
|
| Rate for Payer: Vantage Medical Group Senior |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
NDG4080770B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.25
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
1743780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.51
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
1743780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
IP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
1711928
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.55
|
| Rate for Payer: Heritage Provider Network Senior |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
OP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
1711928
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.88
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.76
|
| Rate for Payer: Dignity Health Senior |
$15.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.76
|
| Rate for Payer: Vantage Medical Group Senior |
$15.76
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
OP
|
$86.37
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
ERX214124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$73.41 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.78
|
| Rate for Payer: Blue Shield of California Commercial |
$53.64
|
| Rate for Payer: Blue Shield of California EPN |
$50.70
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.41
|
| Rate for Payer: Dignity Health Senior |
$73.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.46
|
| Rate for Payer: Heritage Provider Network Senior |
$53.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.59
|
| Rate for Payer: Multiplan Commercial |
$64.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.41
|
| Rate for Payer: Vantage Medical Group Senior |
$73.41
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
IP
|
$86.37
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
ERX214124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$64.78 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.34
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.47
|
| Rate for Payer: Heritage Provider Network Senior |
$58.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.59
|
| Rate for Payer: Multiplan Commercial |
$64.78
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
CPT J0750
|
| Hospital Charge Code |
1710978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: IEHP Medi-Cal |
$1.08
|
| Rate for Payer: IEHP Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
CPT J0750
|
| Hospital Charge Code |
1710978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-01
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-11
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-11
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-58
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Senior |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Senior |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Senior |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-58
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-01
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
1754284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
|
