|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 29300-147-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 47335-902-88
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Media |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 29300-147-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 68180-445-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Media |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-01
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
OP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
1710542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.18
|
| Rate for Payer: BCBS Transplant Transplant |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: Dignity Health Media |
$7.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
IP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
1710542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 0185-4346-01
|
| Hospital Charge Code |
1710761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 0185-4346-01
|
| Hospital Charge Code |
1710761
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
IP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
1711954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Blue Shield of California Commercial |
$5.60
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$5.50
|
| Rate for Payer: Cigna of CA PPO |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.11
|
| Rate for Payer: Prime Health Services Commercial |
$6.68
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
OP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
1711954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.68
|
| Rate for Payer: BCBS Transplant Transplant |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California EPN |
$4.59
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$5.50
|
| Rate for Payer: Cigna of CA PPO |
$5.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.68
|
| Rate for Payer: Dignity Health Media |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$5.11
|
| Rate for Payer: Prime Health Services Commercial |
$6.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]
|
Facility
IP
|
$559.21
|
|
|
Service Code
|
CPT J2770
|
| Hospital Charge Code |
1753511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.21 |
| Max. Negotiated Rate |
$475.33 |
| Rate for Payer: Blue Shield of California Commercial |
$398.16
|
| Rate for Payer: Blue Shield of California EPN |
$286.32
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cigna of CA HMO |
$391.45
|
| Rate for Payer: Cigna of CA PPO |
$391.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$223.68
|
| Rate for Payer: Galaxy Health WC |
$475.33
|
| Rate for Payer: Global Benefits Group Commercial |
$335.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.21
|
| Rate for Payer: Multiplan Commercial |
$447.37
|
| Rate for Payer: Networks By Design Commercial |
$279.60
|
| Rate for Payer: Prime Health Services Commercial |
$475.33
|
|
|
QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]
|
Facility
OP
|
$559.21
|
|
|
Service Code
|
CPT J2770
|
| Hospital Charge Code |
1753511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.21 |
| Max. Negotiated Rate |
$2,890.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,890.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$617.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$543.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$543.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.06
|
| Rate for Payer: BCBS Transplant Transplant |
$335.53
|
| Rate for Payer: Blue Shield of California Commercial |
$412.14
|
| Rate for Payer: Blue Shield of California EPN |
$532.58
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cigna of CA HMO |
$391.45
|
| Rate for Payer: Cigna of CA PPO |
$391.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.96
|
| Rate for Payer: Dignity Health Media |
$493.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$543.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$493.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.97
|
| Rate for Payer: Galaxy Health WC |
$475.33
|
| Rate for Payer: Global Benefits Group Commercial |
$335.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$419.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$810.11
|
| Rate for Payer: IEHP Medi-Cal |
$800.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$800.23
|
| Rate for Payer: IEHP Medicare Advantage |
$493.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$622.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$661.92
|
| Rate for Payer: Multiplan Commercial |
$447.37
|
| Rate for Payer: Networks By Design Commercial |
$279.60
|
| Rate for Payer: Prime Health Services Commercial |
$475.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$335.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$279.60
|
| Rate for Payer: United Healthcare HMO Rider |
$279.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$279.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$543.37
|
| Rate for Payer: Vantage Medical Group Senior |
$493.97
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
OP
|
$447.37
|
|
|
Service Code
|
CPT 90377
|
| Hospital Charge Code |
NDG111036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$1,781.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,781.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$281.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$281.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$775.17
|
| Rate for Payer: BCBS Transplant Transplant |
$268.42
|
| Rate for Payer: Blue Shield of California Commercial |
$329.71
|
| Rate for Payer: Blue Shield of California EPN |
$261.26
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cigna of CA HMO |
$313.16
|
| Rate for Payer: Cigna of CA PPO |
$313.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.46
|
| Rate for Payer: Dignity Health Media |
$256.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$256.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$256.30
|
| Rate for Payer: Galaxy Health WC |
$380.26
|
| Rate for Payer: Global Benefits Group Commercial |
$268.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$335.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$420.34
|
| Rate for Payer: IEHP Medi-Cal |
$415.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$415.21
|
| Rate for Payer: IEHP Medicare Advantage |
$256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.45
|
| Rate for Payer: Multiplan Commercial |
$357.90
|
| Rate for Payer: Networks By Design Commercial |
$223.68
|
| Rate for Payer: Prime Health Services Commercial |
$380.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Other HMO |
$223.68
|
| Rate for Payer: United Healthcare HMO Rider |
$223.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.94
|
| Rate for Payer: Vantage Medical Group Senior |
$256.30
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
IP
|
$447.37
|
|
|
Service Code
|
CPT 90377
|
| Hospital Charge Code |
NDG111036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$380.26 |
| Rate for Payer: Blue Shield of California Commercial |
$318.53
|
| Rate for Payer: Blue Shield of California EPN |
$229.05
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cigna of CA HMO |
$313.16
|
| Rate for Payer: Cigna of CA PPO |
$313.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.95
|
| Rate for Payer: Galaxy Health WC |
$380.26
|
| Rate for Payer: Global Benefits Group Commercial |
$268.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$357.90
|
| Rate for Payer: Networks By Design Commercial |
$223.68
|
| Rate for Payer: Prime Health Services Commercial |
$380.26
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
IP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$694.11 |
| Rate for Payer: Blue Shield of California Commercial |
$581.42
|
| Rate for Payer: Blue Shield of California EPN |
$418.10
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$326.64
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Multiplan Commercial |
$653.28
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
OP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,016.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$362.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$318.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: BCBS Transplant Transplant |
$489.96
|
| Rate for Payer: Blue Shield of California Commercial |
$601.83
|
| Rate for Payer: Blue Shield of California EPN |
$402.26
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$434.97
|
| Rate for Payer: Dignity Health Media |
$289.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$289.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$289.98
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$612.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$475.57
|
| Rate for Payer: IEHP Medi-Cal |
$469.77
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$469.77
|
| Rate for Payer: IEHP Medicare Advantage |
$289.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$388.57
|
| Rate for Payer: Multiplan Commercial |
$653.28
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$489.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$489.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.30
|
| Rate for Payer: United Healthcare All Other HMO |
$408.30
|
| Rate for Payer: United Healthcare HMO Rider |
$408.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$434.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: Vantage Medical Group Senior |
$289.98
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
OP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$2,257.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,257.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.86
|
| Rate for Payer: BCBS Transplant Transplant |
$291.72
|
| Rate for Payer: Blue Shield of California Commercial |
$358.33
|
| Rate for Payer: Blue Shield of California EPN |
$416.53
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cigna of CA HMO |
$340.34
|
| Rate for Payer: Cigna of CA PPO |
$340.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: Dignity Health Media |
$324.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.74
|
| Rate for Payer: Galaxy Health WC |
$413.27
|
| Rate for Payer: Global Benefits Group Commercial |
$291.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$364.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$532.58
|
| Rate for Payer: IEHP Medi-Cal |
$526.09
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$526.09
|
| Rate for Payer: IEHP Medicare Advantage |
$324.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.16
|
| Rate for Payer: Multiplan Commercial |
$388.96
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$413.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.10
|
| Rate for Payer: United Healthcare All Other HMO |
$243.10
|
| Rate for Payer: United Healthcare HMO Rider |
$243.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
