|
4A133BC
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2763
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A140B1
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2764
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A140B3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2765
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A143B1
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2766
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A143B3
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2767
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
5A02116
|
Facility
|
IP
|
$129,104.00
|
|
| Hospital Charge Code |
2769
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
5A02116
|
Facility
|
IP
|
$129,104.00
|
|
| Hospital Charge Code |
2768
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
5A0211D
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2770
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
5A02216
|
Facility
|
IP
|
$129,104.00
|
|
| Hospital Charge Code |
2772
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
5A02216
|
Facility
|
IP
|
$129,104.00
|
|
| Hospital Charge Code |
2771
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
5A1213Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2773
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
8E023DZ
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2774
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.34
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.39
|
| 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 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| 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 |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| 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 Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.44
|
| 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 300 MG TABLET [24438]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| 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 |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Cash Price |
$1.65
|
| 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 Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| 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
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.65
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$1.86
|
| 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
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| 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 |
$7.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cash Price |
$5.82
|
| 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 Medi-Cal |
$9.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| 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 |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| 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 300 MG TABLET [24438]
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.15
|
| Rate for Payer: Cash Price |
$5.82
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| 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 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
OP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$132.51 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.74
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cigna of CA HMO |
$109.13
|
| Rate for Payer: Cigna of CA PPO |
$109.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.13
|
| Rate for Payer: Multiplan Commercial |
$124.72
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.95
|
| Rate for Payer: United Healthcare All Other HMO |
$77.95
|
| Rate for Payer: United Healthcare HMO Rider |
$77.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.51
|
| Rate for Payer: Vantage Medical Group Senior |
$132.51
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
IP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$132.51 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Blue Shield of California Commercial |
$115.05
|
| Rate for Payer: Blue Shield of California EPN |
$75.77
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cigna of CA HMO |
$109.13
|
| Rate for Payer: Cigna of CA PPO |
$109.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.42
|
| Rate for Payer: Multiplan Commercial |
$124.72
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$2.20
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| 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 |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.46
|
| Rate for Payer: Cash Price |
$2.20
|
| 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 Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.80
|
| 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
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$279.94
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.97
|
| Rate for Payer: United Healthcare All Other HMO |
$174.97
|
| Rate for Payer: United Healthcare HMO Rider |
$174.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.89
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$258.25
|
| Rate for Payer: Blue Shield of California EPN |
$170.07
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.98
|
| Rate for Payer: Multiplan Commercial |
$279.94
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$258.25
|
| Rate for Payer: Blue Shield of California EPN |
$170.07
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.98
|
| Rate for Payer: Multiplan Commercial |
$279.94
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
