|
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
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| 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: 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
|
| 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
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| 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 50 MG TABLET [219902]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| 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 50 MG TABLET [219902]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| 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
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
IP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California Commercial |
$88.33
|
| Rate for Payer: Blue Shield of California EPN |
$58.17
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna of CA HMO |
$83.78
|
| Rate for Payer: Cigna of CA PPO |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.88
|
| Rate for Payer: EPIC Health Plan Senior |
$47.88
|
| Rate for Payer: Galaxy Health WC |
$101.74
|
| Rate for Payer: Global Benefits Group Commercial |
$71.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.73
|
| Rate for Payer: Multiplan Commercial |
$95.75
|
| Rate for Payer: Networks By Design Commercial |
$77.80
|
| Rate for Payer: Prime Health Services Commercial |
$101.74
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
OP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.50
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna of CA HMO |
$83.78
|
| Rate for Payer: Cigna of CA PPO |
$83.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.88
|
| Rate for Payer: EPIC Health Plan Senior |
$47.88
|
| Rate for Payer: Galaxy Health WC |
$101.74
|
| Rate for Payer: Global Benefits Group Commercial |
$71.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.78
|
| Rate for Payer: Multiplan Commercial |
$95.75
|
| Rate for Payer: Networks By Design Commercial |
$77.80
|
| Rate for Payer: Prime Health Services Commercial |
$101.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.84
|
| Rate for Payer: United Healthcare All Other HMO |
$59.84
|
| Rate for Payer: United Healthcare HMO Rider |
$59.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.74
|
| Rate for Payer: Vantage Medical Group Senior |
$101.74
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
IP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$539.07 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Blue Shield of California Commercial |
$468.04
|
| Rate for Payer: Blue Shield of California EPN |
$308.22
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.68
|
| Rate for Payer: EPIC Health Plan Senior |
$253.68
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.21
|
| Rate for Payer: Multiplan Commercial |
$507.36
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
OP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$539.07 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.93
|
| Rate for Payer: Blue Shield of California Commercial |
$10.31
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.17
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$507.36
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Vantage Medical Group Senior |
$10.09
|
|
|
ACARBOSE 25 MG TABLET [22148]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 64380-758-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| 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 |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ACARBOSE 25 MG TABLET [22148]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 64380-758-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.20
|
| 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: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
HCPCS J0134
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| 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 |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
HCPCS J0137
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
HCPCS J0137
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
HCPCS J0134
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| 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 |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| 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 |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
ACETAMINOPHEN 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [4080108021]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
ACETAMINOPHEN 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [4080108021]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [103]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 0472-1201-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [103]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 0472-1201-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
