CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
OP
|
$2.43
|
|
Service Code
|
NDC 60687-447-11
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$2.07 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.34
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
Rate for Payer: Blue Distinction Transplant |
$1.46
|
Rate for Payer: Blue Shield of California Commercial |
$1.79
|
Rate for Payer: Blue Shield of California EPN |
$1.42
|
Rate for Payer: Cash Price |
$1.09
|
Rate for Payer: Cigna of CA HMO |
$1.70
|
Rate for Payer: Cigna of CA PPO |
$1.70
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
Rate for Payer: Dignity Health Media |
$2.07
|
Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
Rate for Payer: EPIC Health Plan Transplant |
$0.97
|
Rate for Payer: Galaxy Health WC |
$2.07
|
Rate for Payer: Global Benefits Group Commercial |
$1.46
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.82
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.62
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
Rate for Payer: Multiplan Commercial |
$1.94
|
Rate for Payer: Networks By Design Commercial |
$1.58
|
Rate for Payer: Prime Health Services Commercial |
$2.07
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.46
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.46
|
Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
Rate for Payer: United Healthcare All Other HMO |
$1.22
|
Rate for Payer: United Healthcare HMO Rider |
$1.22
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
IP
|
$18.76
|
|
Service Code
|
NDC 0025-1525-34
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$4.50 |
Max. Negotiated Rate |
$15.95 |
Rate for Payer: Blue Shield of California Commercial |
$13.36
|
Rate for Payer: Blue Shield of California EPN |
$9.61
|
Rate for Payer: Cash Price |
$8.44
|
Rate for Payer: Cigna of CA HMO |
$13.13
|
Rate for Payer: Cigna of CA PPO |
$13.13
|
Rate for Payer: EPIC Health Plan Commercial |
$7.50
|
Rate for Payer: Galaxy Health WC |
$15.95
|
Rate for Payer: Global Benefits Group Commercial |
$11.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
Rate for Payer: Multiplan Commercial |
$15.01
|
Rate for Payer: Networks By Design Commercial |
$12.19
|
Rate for Payer: Prime Health Services Commercial |
$15.95
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
IP
|
$6.04
|
|
Service Code
|
NDC 51079-215-20
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.45 |
Max. Negotiated Rate |
$5.13 |
Rate for Payer: Blue Shield of California Commercial |
$4.30
|
Rate for Payer: Blue Shield of California EPN |
$3.09
|
Rate for Payer: Cash Price |
$2.72
|
Rate for Payer: Cigna of CA HMO |
$4.23
|
Rate for Payer: Cigna of CA PPO |
$4.23
|
Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
Rate for Payer: Galaxy Health WC |
$5.13
|
Rate for Payer: Global Benefits Group Commercial |
$3.62
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
Rate for Payer: Multiplan Commercial |
$4.83
|
Rate for Payer: Networks By Design Commercial |
$3.93
|
Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
OP
|
$1.23
|
|
Service Code
|
NDC 59762-1517-1
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$1.05 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.05
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
Rate for Payer: Blue Distinction Transplant |
$0.74
|
Rate for Payer: Blue Shield of California Commercial |
$0.91
|
Rate for Payer: Blue Shield of California EPN |
$0.72
|
Rate for Payer: Cash Price |
$0.55
|
Rate for Payer: Cigna of CA HMO |
$0.86
|
Rate for Payer: Cigna of CA PPO |
$0.86
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
Rate for Payer: Dignity Health Media |
$1.05
|
Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
Rate for Payer: Galaxy Health WC |
$1.05
|
Rate for Payer: Global Benefits Group Commercial |
$0.74
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.92
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
Rate for Payer: Multiplan Commercial |
$0.98
|
Rate for Payer: Networks By Design Commercial |
$0.80
|
Rate for Payer: Prime Health Services Commercial |
$1.05
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
Rate for Payer: United Healthcare All Other HMO |
$0.62
|
Rate for Payer: United Healthcare HMO Rider |
$0.62
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$9,300.02
|
|
Service Code
|
APR-DRG 3832
|
Min. Negotiated Rate |
$7,134.10 |
Max. Negotiated Rate |
$9,300.02 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,134.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,300.02
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$6,785.26
|
|
Service Code
|
APR-DRG 3831
|
Min. Negotiated Rate |
$5,205.01 |
Max. Negotiated Rate |
$6,785.26 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,205.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,785.26
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$25,277.12
|
|
Service Code
|
APR-DRG 3834
|
Min. Negotiated Rate |
$19,390.22 |
Max. Negotiated Rate |
$25,277.12 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,390.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,277.12
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$13,836.54
|
|
Service Code
|
APR-DRG 3833
|
Min. Negotiated Rate |
$10,614.08 |
Max. Negotiated Rate |
$13,836.54 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,614.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,836.54
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
|
OP
|
$1,680.32
|
|
Service Code
|
CPT J9119
|
Hospital Charge Code |
NDG222941
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$27.46 |
Max. Negotiated Rate |
$1,428.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$54.09
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.33
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.21
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.21
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.25
|
Rate for Payer: Blue Distinction Transplant |
$1,008.19
|
Rate for Payer: Blue Shield of California Commercial |
$1,238.40
|
Rate for Payer: Blue Shield of California EPN |
$981.31
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cigna of CA HMO |
$1,176.22
|
Rate for Payer: Cigna of CA PPO |
$1,176.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$34.33
|
Rate for Payer: Dignity Health Media |
$30.21
|
Rate for Payer: Dignity Health Medi-Cal |
$30.21
|
Rate for Payer: EPIC Health Plan Commercial |
$37.07
|
Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.46
|
Rate for Payer: EPIC Health Plan Transplant |
$27.46
|
Rate for Payer: Galaxy Health WC |
$1,428.27
|
Rate for Payer: Global Benefits Group Commercial |
$1,008.19
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,260.24
|
Rate for Payer: Heritage Provider Network Commercial |
$45.04
|
Rate for Payer: Heritage Provider Network Transplant |
$45.04
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.49
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$44.49
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,120.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.65
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
Rate for Payer: LLUH Dept of Risk Management WC |
$403.28
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.60
|
Rate for Payer: Molina Healthcare of CA Medicare |
$36.80
|
Rate for Payer: Multiplan Commercial |
$1,344.26
|
Rate for Payer: Networks By Design Commercial |
$840.16
|
Rate for Payer: Prime Health Services Commercial |
$1,428.27
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,008.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,008.19
|
Rate for Payer: United Healthcare All Other Commercial |
$840.16
|
Rate for Payer: United Healthcare All Other HMO |
$840.16
|
Rate for Payer: United Healthcare HMO Rider |
$840.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$840.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.33
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$30.21
|
Rate for Payer: Vantage Medical Group Senior |
$30.21
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
|
IP
|
$1,680.32
|
|
Service Code
|
CPT J9119
|
Hospital Charge Code |
NDG222941
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$403.28 |
Max. Negotiated Rate |
$1,428.27 |
Rate for Payer: Blue Shield of California Commercial |
$1,196.39
|
Rate for Payer: Blue Shield of California EPN |
$860.32
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cigna of CA HMO |
$1,176.22
|
Rate for Payer: Cigna of CA PPO |
$1,176.22
|
Rate for Payer: EPIC Health Plan Commercial |
$672.13
|
Rate for Payer: EPIC Health Plan Transplant |
$672.13
|
Rate for Payer: Galaxy Health WC |
$1,428.27
|
Rate for Payer: Global Benefits Group Commercial |
$1,008.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,120.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$403.28
|
Rate for Payer: Multiplan Commercial |
$1,344.26
|
Rate for Payer: Networks By Design Commercial |
$840.16
|
Rate for Payer: Prime Health Services Commercial |
$1,428.27
|
Rate for Payer: United Healthcare All Other Commercial |
$634.49
|
Rate for Payer: United Healthcare All Other HMO |
$619.70
|
Rate for Payer: United Healthcare HMO Rider |
$606.26
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$554.51
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.23
|
|
Service Code
|
NDC 68180-440-01
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: Blue Distinction Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.23
|
|
Service Code
|
NDC 0093-4175-73
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.23
|
|
Service Code
|
NDC 68180-440-01
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.10
|
|
Service Code
|
NDC 67877-544-68
|
Hospital Charge Code |
NDG9501B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
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: 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: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.23
|
|
Service Code
|
NDC 0093-4175-73
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: Blue Distinction Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.10
|
|
Service Code
|
NDC 67877-544-68
|
Hospital Charge Code |
NDG9501B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
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 |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: Blue Distinction Transplant |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
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 |
$0.06
|
Rate for Payer: Health Plan of Nevada (Sierra) 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 |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.07
|
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 |
$0.05
|
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 |
$0.05
|
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
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.28
|
|
Service Code
|
NDC 0093-4177-73
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
Rate for Payer: Blue Distinction Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
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 |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.25
|
|
Service Code
|
NDC 0093-4177-74
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Blue Shield of California Commercial |
$0.18
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO |
$0.18
|
Rate for Payer: Cigna of CA PPO |
$0.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Galaxy Health WC |
$0.21
|
Rate for Payer: Global Benefits Group Commercial |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.20
|
Rate for Payer: Networks By Design Commercial |
$0.16
|
Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.16
|
|
Service Code
|
NDC 67877-545-68
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: Blue Distinction Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.28
|
|
Service Code
|
NDC 0093-4177-73
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
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 |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.16
|
|
Service Code
|
NDC 67877-545-88
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: Blue Distinction Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.25
|
|
Service Code
|
NDC 0093-4177-74
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
Rate for Payer: Blue Distinction Transplant |
$0.15
|
Rate for Payer: Blue Shield of California Commercial |
$0.18
|
Rate for Payer: Blue Shield of California EPN |
$0.15
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO |
$0.18
|
Rate for Payer: Cigna of CA PPO |
$0.18
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
Rate for Payer: Dignity Health Media |
$0.21
|
Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
Rate for Payer: Galaxy Health WC |
$0.21
|
Rate for Payer: Global Benefits Group Commercial |
$0.15
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.20
|
Rate for Payer: Networks By Design Commercial |
$0.16
|
Rate for Payer: Prime Health Services Commercial |
$0.21
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
Rate for Payer: United Healthcare All Other HMO |
$0.13
|
Rate for Payer: United Healthcare HMO Rider |
$0.13
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.16
|
|
Service Code
|
NDC 67877-545-88
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.16
|
|
Service Code
|
NDC 67877-545-68
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
CEPHALEXIN 250 MG CAPSULE [9499]
|
Facility
|
OP
|
$0.48
|
|
Service Code
|
NDC 50268-151-15
|
Hospital Charge Code |
1710149
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
Rate for Payer: Blue Distinction Transplant |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
Rate for Payer: Dignity Health Media |
$0.41
|
Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.38
|
Rate for Payer: Networks By Design Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
Rate for Payer: United Healthcare All Other HMO |
$0.24
|
Rate for Payer: United Healthcare HMO Rider |
$0.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|