|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
NDG24439
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Distinction Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Media |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
NDG24439
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.42
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: Blue Distinction Transplant |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Media |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.31
|
| Rate for Payer: Blue Distinction Transplant |
$6.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7.80
|
| Rate for Payer: Blue Shield of California EPN |
$6.18
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.00
|
| Rate for Payer: Dignity Health Media |
$9.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.00
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
OP
|
$141.50
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
ERX207101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.31
|
| Rate for Payer: Blue Distinction Transplant |
$84.90
|
| Rate for Payer: Blue Shield of California Commercial |
$104.29
|
| Rate for Payer: Blue Shield of California EPN |
$82.64
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cigna of CA HMO |
$99.05
|
| Rate for Payer: Cigna of CA PPO |
$99.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.28
|
| Rate for Payer: Dignity Health Media |
$120.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.60
|
| Rate for Payer: Galaxy Health WC |
$120.28
|
| Rate for Payer: Global Benefits Group Commercial |
$84.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$113.20
|
| Rate for Payer: Networks By Design Commercial |
$91.98
|
| Rate for Payer: Prime Health Services Commercial |
$120.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.75
|
| Rate for Payer: United Healthcare All Other HMO |
$70.75
|
| Rate for Payer: United Healthcare HMO Rider |
$70.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.28
|
| Rate for Payer: Vantage Medical Group Senior |
$120.28
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
IP
|
$141.50
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
ERX207101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Blue Shield of California Commercial |
$100.75
|
| Rate for Payer: Blue Shield of California EPN |
$72.45
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cigna of CA HMO |
$99.05
|
| Rate for Payer: Cigna of CA PPO |
$99.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.60
|
| Rate for Payer: Galaxy Health WC |
$120.28
|
| Rate for Payer: Global Benefits Group Commercial |
$84.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$113.20
|
| Rate for Payer: Networks By Design Commercial |
$91.98
|
| Rate for Payer: Prime Health Services Commercial |
$120.28
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
1711932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Blue Shield of California Commercial |
$2.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
1711932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.95
|
| Rate for Payer: Blue Shield of California EPN |
$2.34
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Media |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
|
OP
|
$1,655.88
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
1720952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$1,407.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.06
|
| Rate for Payer: Blue Distinction Transplant |
$993.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,220.38
|
| Rate for Payer: Blue Shield of California EPN |
$56.43
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Cigna of CA HMO |
$1,159.12
|
| Rate for Payer: Cigna of CA PPO |
$1,159.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.74
|
| Rate for Payer: Dignity Health Media |
$43.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.16
|
| Rate for Payer: Galaxy Health WC |
$1,407.50
|
| Rate for Payer: Global Benefits Group Commercial |
$993.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,241.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$70.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$69.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,104.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$1,324.70
|
| Rate for Payer: Networks By Design Commercial |
$827.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$993.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$993.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$827.94
|
| Rate for Payer: United Healthcare All Other HMO |
$827.94
|
| Rate for Payer: United Healthcare HMO Rider |
$827.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$827.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Vantage Medical Group Senior |
$43.16
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
|
IP
|
$1,655.88
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
1720952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$397.41 |
| Max. Negotiated Rate |
$1,407.50 |
| Rate for Payer: Blue Shield of California Commercial |
$1,178.99
|
| Rate for Payer: Blue Shield of California EPN |
$847.81
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Cigna of CA HMO |
$1,159.12
|
| Rate for Payer: Cigna of CA PPO |
$1,159.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$662.35
|
| Rate for Payer: Galaxy Health WC |
$1,407.50
|
| Rate for Payer: Global Benefits Group Commercial |
$993.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,104.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.41
|
| Rate for Payer: Multiplan Commercial |
$1,324.70
|
| Rate for Payer: Networks By Design Commercial |
$827.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.26
|
| Rate for Payer: United Healthcare All Other HMO |
$610.69
|
| Rate for Payer: United Healthcare HMO Rider |
$597.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.44
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$12,506.45
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$9,593.76 |
| Max. Negotiated Rate |
$12,506.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,593.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,506.45
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$7,335.03
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$5,626.74 |
| Max. Negotiated Rate |
$7,335.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,626.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,335.03
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$9,473.82
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$7,267.42 |
| Max. Negotiated Rate |
$9,473.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,267.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,473.82
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$21,136.09
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$16,213.61 |
| Max. Negotiated Rate |
$21,136.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,213.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,136.09
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
ERX219901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Blue Shield of California Commercial |
$221.75
|
| Rate for Payer: Blue Shield of California EPN |
$159.46
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
ERX219901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$204.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.56
|
| Rate for Payer: Blue Distinction Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$229.53
|
| Rate for Payer: Blue Shield of California EPN |
$181.88
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: Dignity Health Media |
$264.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$233.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
ERX219900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Blue Shield of California Commercial |
$221.75
|
| Rate for Payer: Blue Shield of California EPN |
$159.46
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
ERX219900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$204.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.56
|
| Rate for Payer: Blue Distinction Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$229.53
|
| Rate for Payer: Blue Shield of California EPN |
$181.88
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: Dignity Health Media |
$264.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$233.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
ERX219899
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Blue Shield of California Commercial |
$221.75
|
| Rate for Payer: Blue Shield of California EPN |
$159.46
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
ERX219899
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$204.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.56
|
| Rate for Payer: Blue Distinction Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$229.53
|
| Rate for Payer: Blue Shield of California EPN |
$181.88
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: Dignity Health Media |
$264.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$233.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Blue Shield of California Commercial |
$221.75
|
| Rate for Payer: Blue Shield of California EPN |
$159.46
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
ERX219902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$264.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$204.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.56
|
| Rate for Payer: Blue Distinction Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$229.53
|
| Rate for Payer: Blue Shield of California EPN |
$181.88
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: Dignity Health Media |
$264.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$233.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$249.15
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
IP
|
$108.87
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
1712538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Blue Shield of California Commercial |
$77.52
|
| Rate for Payer: Blue Shield of California EPN |
$55.74
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cigna of CA HMO |
$76.21
|
| Rate for Payer: Cigna of CA PPO |
$76.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: Galaxy Health WC |
$92.54
|
| Rate for Payer: Global Benefits Group Commercial |
$65.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.13
|
| Rate for Payer: Multiplan Commercial |
$87.10
|
| Rate for Payer: Networks By Design Commercial |
$70.77
|
| Rate for Payer: Prime Health Services Commercial |
$92.54
|
|
