|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$7.50
|
|
|
Service Code
|
NDC 42806-503-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.47
|
| Rate for Payer: BCBS Transplant Transplant |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$5.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.38
|
| Rate for Payer: Dignity Health Media |
$6.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6.38
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$9.20
|
|
|
Service Code
|
NDC 50268-796-11
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: BCBS Transplant Transplant |
$5.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.78
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cigna of CA HMO |
$6.44
|
| Rate for Payer: Cigna of CA PPO |
$6.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.82
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.68
|
| Rate for Payer: Galaxy Health WC |
$7.82
|
| Rate for Payer: Global Benefits Group Commercial |
$5.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$7.36
|
| Rate for Payer: Networks By Design Commercial |
$5.98
|
| Rate for Payer: Prime Health Services Commercial |
$7.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.82
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$1.23
|
|
|
Service Code
|
NDC 0591-3159-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.86
|
| Rate for Payer: Cigna of CA PPO |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.82
|
| 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
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$7.15
|
|
|
Service Code
|
NDC 60687-100-11
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.26
|
| Rate for Payer: BCBS Transplant Transplant |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.08
|
| Rate for Payer: Dignity Health Media |
$6.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.08
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
NDC 70710-1483-1
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Media |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$9.20
|
|
|
Service Code
|
NDC 50268-796-11
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Blue Shield of California Commercial |
$6.55
|
| Rate for Payer: Blue Shield of California EPN |
$4.71
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cigna of CA HMO |
$6.44
|
| Rate for Payer: Cigna of CA PPO |
$6.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.68
|
| Rate for Payer: Galaxy Health WC |
$7.82
|
| Rate for Payer: Global Benefits Group Commercial |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$7.36
|
| Rate for Payer: Networks By Design Commercial |
$5.98
|
| Rate for Payer: Prime Health Services Commercial |
$7.82
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$3.06
|
|
|
Service Code
|
NDC 0378-1730-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$2.14
|
| Rate for Payer: Cigna of CA PPO |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Networks By Design Commercial |
$1.99
|
| Rate for Payer: Prime Health Services Commercial |
$2.60
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$0.95
|
|
|
Service Code
|
NDC 59651-421-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: Dignity Health Media |
$0.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$8.98
|
|
|
Service Code
|
NDC 0904-6221-06
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.35
|
| Rate for Payer: BCBS Transplant Transplant |
$5.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Blue Shield of California EPN |
$5.24
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.63
|
| Rate for Payer: Dignity Health Media |
$7.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.18
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4.49
|
| Rate for Payer: United Healthcare HMO Rider |
$4.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.63
|
| Rate for Payer: Vantage Medical Group Senior |
$7.63
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$7.15
|
|
|
Service Code
|
NDC 60687-100-11
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$7.50
|
|
|
Service Code
|
NDC 42806-503-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Blue Shield of California Commercial |
$5.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$1.23
|
|
|
Service Code
|
NDC 0591-3159-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: BCBS Transplant Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.55
|
| 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
NDC 70710-1483-1
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$3.06
|
|
|
Service Code
|
NDC 0378-1730-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Galaxy Health WC |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: BCBS Transplant Transplant |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$2.14
|
| Rate for Payer: Cigna of CA PPO |
$2.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.60
|
| Rate for Payer: Dignity Health Media |
$2.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Networks By Design Commercial |
$1.99
|
| Rate for Payer: Prime Health Services Commercial |
$2.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2.60
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$7.15
|
|
|
Service Code
|
NDC 60687-100-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.26
|
| Rate for Payer: BCBS Transplant Transplant |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.08
|
| Rate for Payer: Dignity Health Media |
$6.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.08
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
OP
|
$1.50
|
|
|
Service Code
|
NDC 0527-1326-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: BCBS Transplant Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
IP
|
$0.95
|
|
|
Service Code
|
NDC 59651-421-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]
|
Facility
IP
|
$1.50
|
|
|
Service Code
|
NDC 9994-0803-54
|
| Hospital Charge Code |
1715942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
|
|
URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]
|
Facility
OP
|
$1.50
|
|
|
Service Code
|
NDC 9994-0803-54
|
| Hospital Charge Code |
1715942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: BCBS Transplant Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]
|
Facility
IP
|
$88.99
|
|
|
Service Code
|
CPT J3358
|
| Hospital Charge Code |
NDG215734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Blue Shield of California Commercial |
$63.36
|
| Rate for Payer: Blue Shield of California EPN |
$45.56
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO |
$62.29
|
| Rate for Payer: Cigna of CA PPO |
$62.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.64
|
| Rate for Payer: Global Benefits Group Commercial |
$53.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Multiplan Commercial |
$71.19
|
| Rate for Payer: Networks By Design Commercial |
$44.50
|
| Rate for Payer: Prime Health Services Commercial |
$75.64
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]
|
Facility
OP
|
$88.99
|
|
|
Service Code
|
CPT J3358
|
| Hospital Charge Code |
NDG215734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$79.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$79.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.25
|
| Rate for Payer: BCBS Transplant Transplant |
$53.39
|
| Rate for Payer: Blue Shield of California Commercial |
$65.59
|
| Rate for Payer: Blue Shield of California EPN |
$15.49
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO |
$62.29
|
| Rate for Payer: Cigna of CA PPO |
$62.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.93
|
| Rate for Payer: Dignity Health Media |
$12.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$75.64
|
| Rate for Payer: Global Benefits Group Commercial |
$53.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$20.70
|
| Rate for Payer: IEHP Medi-Cal |
$20.44
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$20.44
|
| Rate for Payer: IEHP Medicare Advantage |
$12.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$71.19
|
| Rate for Payer: Networks By Design Commercial |
$44.50
|
| Rate for Payer: Prime Health Services Commercial |
$75.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.50
|
| Rate for Payer: United Healthcare All Other HMO |
$44.50
|
| Rate for Payer: United Healthcare HMO Rider |
$44.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.62
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]
|
Facility
IP
|
$31,820.40
|
|
|
Service Code
|
CPT J3357
|
| Hospital Charge Code |
NDG108054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,636.90 |
| Max. Negotiated Rate |
$27,047.34 |
| Rate for Payer: Blue Shield of California Commercial |
$22,656.12
|
| Rate for Payer: Blue Shield of California EPN |
$16,292.04
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cigna of CA HMO |
$22,274.28
|
| Rate for Payer: Cigna of CA PPO |
$22,274.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,728.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,728.16
|
| Rate for Payer: Galaxy Health WC |
$27,047.34
|
| Rate for Payer: Global Benefits Group Commercial |
$19,092.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,224.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,123.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,636.90
|
| Rate for Payer: Multiplan Commercial |
$25,456.32
|
| Rate for Payer: Networks By Design Commercial |
$15,910.20
|
| Rate for Payer: Prime Health Services Commercial |
$27,047.34
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]
|
Facility
OP
|
$31,820.40
|
|
|
Service Code
|
CPT J3357
|
| Hospital Charge Code |
NDG108054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$27,047.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$968.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$192.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$169.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: BCBS Transplant Transplant |
$19,092.24
|
| Rate for Payer: Blue Shield of California Commercial |
$23,451.63
|
| Rate for Payer: Blue Shield of California EPN |
$307.77
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cigna of CA HMO |
$22,274.28
|
| Rate for Payer: Cigna of CA PPO |
$22,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$230.93
|
| Rate for Payer: Dignity Health Media |
$153.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$153.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.96
|
| Rate for Payer: Galaxy Health WC |
$27,047.34
|
| Rate for Payer: Global Benefits Group Commercial |
$19,092.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23,865.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$252.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$252.49
|
| Rate for Payer: IEHP Medi-Cal |
$249.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$249.41
|
| Rate for Payer: IEHP Medicare Advantage |
$153.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,224.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,636.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.30
|
| Rate for Payer: Multiplan Commercial |
$25,456.32
|
| Rate for Payer: Networks By Design Commercial |
$15,910.20
|
| Rate for Payer: Prime Health Services Commercial |
$27,047.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,092.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,092.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,910.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15,910.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15,910.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,910.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$230.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.35
|
| Rate for Payer: Vantage Medical Group Senior |
$153.96
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
IP
|
$56,078.58
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$43,018.17 |
| Max. Negotiated Rate |
$56,078.58 |
| Rate for Payer: IEHP Medi-Cal |
$43,018.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,078.58
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
IP
|
$18,137.17
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$13,913.12 |
| Max. Negotiated Rate |
$18,137.17 |
| Rate for Payer: IEHP Medi-Cal |
$13,913.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,137.17
|
|
