|
POLYETHYLENE GLYCOL 3350 4.25 GRAM ORAL POWDER PACKET [232762]
|
Facility
IP
|
$1.37
|
|
|
Service Code
|
NDC 17856-0962-2
|
| Hospital Charge Code |
ERX232762
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.96
|
| Rate for Payer: Cigna of CA PPO |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
|
|
POLYETHYLENE GLYCOL 400 1 % EYE DROPS [232731]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 7430001067
|
| Hospital Charge Code |
NDG232731
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
POLYETHYLENE GLYCOL 400 1 % EYE DROPS [232731]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 7430001067
|
| Hospital Charge Code |
NDG232731
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Media |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
IP
|
$9.58
|
|
|
Service Code
|
NDC 0023-7824-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO |
$6.71
|
| Rate for Payer: Cigna of CA PPO |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.66
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.14
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
OP
|
$1.24
|
|
|
Service Code
|
NDC 61314-628-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: BCBS Transplant Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Media |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
NDC 60758-908-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
IP
|
$1.24
|
|
|
Service Code
|
NDC 61314-628-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
OP
|
$9.58
|
|
|
Service Code
|
NDC 0023-7824-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.71
|
| Rate for Payer: BCBS Transplant Transplant |
$5.75
|
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO |
$6.71
|
| Rate for Payer: Cigna of CA PPO |
$6.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.14
|
| Rate for Payer: Dignity Health Media |
$8.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.66
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.14
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [111465]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
NDC 60758-908-10
|
| Hospital Charge Code |
1740272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Media |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION [6393]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
NDC 55150-234-10
|
| Hospital Charge Code |
1756008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.15
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION [6393]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
NDC 55150-234-10
|
| Hospital Charge Code |
1756008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
POLYOXYL (100) STEARYL ETHER (BULK) 100 % WAX [192296]
|
Facility
IP
|
$1.73
|
|
|
Service Code
|
NDC 5192723020
|
| Hospital Charge Code |
NDG192296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
|
|
POLYOXYL (100) STEARYL ETHER (BULK) 100 % WAX [192296]
|
Facility
OP
|
$1.73
|
|
|
Service Code
|
NDC 5192723020
|
| Hospital Charge Code |
NDG192296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: BCBS Transplant Transplant |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Media |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS [27994]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
NDC 17478-060-12
|
| Hospital Charge Code |
1740338
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS [27994]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
NDC 17478-060-12
|
| Hospital Charge Code |
1740338
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Media |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION [27047]
|
Facility
OP
|
$435.45
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$370.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$285.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$370.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$239.50
|
| Rate for Payer: BCBS Transplant Transplant |
$261.27
|
| Rate for Payer: Blue Shield of California Commercial |
$320.93
|
| Rate for Payer: Blue Shield of California EPN |
$254.30
|
| Rate for Payer: Cash Price |
$195.95
|
| Rate for Payer: Cash Price |
$195.95
|
| Rate for Payer: Cigna of CA HMO |
$304.82
|
| Rate for Payer: Cigna of CA PPO |
$304.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.13
|
| Rate for Payer: Dignity Health Media |
$370.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$370.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.18
|
| Rate for Payer: Galaxy Health WC |
$370.13
|
| Rate for Payer: Global Benefits Group Commercial |
$261.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$326.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.51
|
| Rate for Payer: Multiplan Commercial |
$348.36
|
| Rate for Payer: Networks By Design Commercial |
$217.72
|
| Rate for Payer: Prime Health Services Commercial |
$370.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.72
|
| Rate for Payer: United Healthcare All Other HMO |
$217.72
|
| Rate for Payer: United Healthcare HMO Rider |
$217.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$370.13
|
| Rate for Payer: Vantage Medical Group Senior |
$370.13
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION [27047]
|
Facility
IP
|
$435.45
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$370.13 |
| Rate for Payer: Cash Price |
$195.95
|
| Rate for Payer: Cigna of CA HMO |
$304.82
|
| Rate for Payer: Cigna of CA PPO |
$304.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.18
|
| Rate for Payer: Galaxy Health WC |
$370.13
|
| Rate for Payer: Blue Shield of California Commercial |
$310.04
|
| Rate for Payer: Blue Shield of California EPN |
$222.95
|
| Rate for Payer: Global Benefits Group Commercial |
$261.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.51
|
| Rate for Payer: Multiplan Commercial |
$348.36
|
| Rate for Payer: Networks By Design Commercial |
$217.72
|
| Rate for Payer: Prime Health Services Commercial |
$370.13
|
|
|
PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION [117872]
|
Facility
IP
|
$429.33
|
|
|
Service Code
|
NDC 10122-510-03
|
| Hospital Charge Code |
1720929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: Blue Shield of California Commercial |
$305.68
|
| Rate for Payer: Blue Shield of California EPN |
$219.82
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.73
|
| Rate for Payer: Galaxy Health WC |
$364.93
|
| Rate for Payer: Global Benefits Group Commercial |
$257.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$343.46
|
| Rate for Payer: Networks By Design Commercial |
$279.06
|
| Rate for Payer: Prime Health Services Commercial |
$364.93
|
|
|
PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION [117872]
|
Facility
OP
|
$429.33
|
|
|
Service Code
|
NDC 10122-510-03
|
| Hospital Charge Code |
1720929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$281.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$364.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$236.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.79
|
| Rate for Payer: BCBS Transplant Transplant |
$257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$316.42
|
| Rate for Payer: Blue Shield of California EPN |
$250.73
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna of CA HMO |
$274.77
|
| Rate for Payer: Cigna of CA PPO |
$317.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.93
|
| Rate for Payer: Dignity Health Media |
$364.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.73
|
| Rate for Payer: Galaxy Health WC |
$364.93
|
| Rate for Payer: Global Benefits Group Commercial |
$257.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$322.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$343.46
|
| Rate for Payer: Networks By Design Commercial |
$279.06
|
| Rate for Payer: Prime Health Services Commercial |
$364.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.66
|
| Rate for Payer: United Healthcare All Other HMO |
$214.66
|
| Rate for Payer: United Healthcare HMO Rider |
$214.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.93
|
| Rate for Payer: Vantage Medical Group Senior |
$364.93
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
OP
|
$25,980.00
|
|
|
Service Code
|
CPT J9600
|
| Hospital Charge Code |
ERX14472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,590.46 |
| Max. Negotiated Rate |
$138,342.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138,342.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28,535.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,110.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,110.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,590.46
|
| Rate for Payer: BCBS Transplant Transplant |
$15,588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,147.26
|
| Rate for Payer: Blue Shield of California EPN |
$25,248.00
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cigna of CA HMO |
$18,186.00
|
| Rate for Payer: Cigna of CA PPO |
$18,186.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,242.24
|
| Rate for Payer: Dignity Health Media |
$22,828.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,110.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,818.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,828.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,828.16
|
| Rate for Payer: Galaxy Health WC |
$22,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,588.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,485.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,438.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$37,438.18
|
| Rate for Payer: IEHP Medi-Cal |
$36,981.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$36,981.62
|
| Rate for Payer: IEHP Medicare Advantage |
$22,828.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,898.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,828.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,763.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,589.73
|
| Rate for Payer: Multiplan Commercial |
$20,784.00
|
| Rate for Payer: Networks By Design Commercial |
$12,990.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,083.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,588.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,990.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,990.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,990.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,242.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,110.98
|
| Rate for Payer: Vantage Medical Group Senior |
$22,828.16
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
IP
|
$25,980.00
|
|
|
Service Code
|
CPT J9600
|
| Hospital Charge Code |
ERX14472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,235.20 |
| Max. Negotiated Rate |
$22,083.00 |
| Rate for Payer: Networks By Design Commercial |
$12,990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,497.76
|
| Rate for Payer: Blue Shield of California EPN |
$13,301.76
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cigna of CA HMO |
$18,186.00
|
| Rate for Payer: Cigna of CA PPO |
$18,186.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,392.00
|
| Rate for Payer: Galaxy Health WC |
$22,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,898.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,235.20
|
| Rate for Payer: Multiplan Commercial |
$20,784.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,083.00
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$19.24
|
|
|
Service Code
|
NDC 0527-2133-35
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.46
|
| Rate for Payer: BCBS Transplant Transplant |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$14.18
|
| Rate for Payer: Blue Shield of California EPN |
$11.24
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$13.47
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.35
|
| Rate for Payer: Dignity Health Media |
$16.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$15.39
|
| Rate for Payer: Networks By Design Commercial |
$12.51
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9.62
|
| Rate for Payer: United Healthcare HMO Rider |
$9.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16.35
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.72
|
| Rate for Payer: BCBS Transplant Transplant |
$33.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.71
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.11
|
| Rate for Payer: Dignity Health Media |
$48.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.30
|
| Rate for Payer: United Healthcare All Other HMO |
$28.30
|
| Rate for Payer: United Healthcare HMO Rider |
$28.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Vantage Medical Group Senior |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Blue Shield of California Commercial |
$40.30
|
| Rate for Payer: Blue Shield of California EPN |
$28.98
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
NDC 70748-258-07
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.36
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Media |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
