|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$148.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.65
|
| Rate for Payer: Blue Distinction Transplant |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.54
|
| Rate for Payer: Blue Shield of California EPN |
$79.98
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: Dignity Health Media |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$120.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.78
|
| Rate for Payer: Multiplan Commercial |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other HMO |
$9.18
|
| Rate for Payer: United Healthcare HMO Rider |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$148.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.65
|
| Rate for Payer: Blue Distinction Transplant |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.54
|
| Rate for Payer: Blue Shield of California EPN |
$79.98
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: Dignity Health Media |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$120.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.78
|
| Rate for Payer: Multiplan Commercial |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other HMO |
$9.18
|
| Rate for Payer: United Healthcare HMO Rider |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
IP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Blue Shield of California Commercial |
$13.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.41
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.94
|
| Rate for Payer: United Healthcare All Other HMO |
$6.77
|
| Rate for Payer: United Healthcare HMO Rider |
$6.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
|
OP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Distinction Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.71
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cigna of CA HMO |
$6.84
|
| Rate for Payer: Cigna of CA PPO |
$6.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: Dignity Health Media |
$8.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.91
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.82
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
|
IP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cigna of CA HMO |
$6.84
|
| Rate for Payer: Cigna of CA PPO |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.82
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$12,137.56
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$9,310.79 |
| Max. Negotiated Rate |
$12,137.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,310.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,137.56
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$78,755.82
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$60,414.00 |
| Max. Negotiated Rate |
$78,755.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60,414.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78,755.82
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$25,381.76
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$19,470.48 |
| Max. Negotiated Rate |
$25,381.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,470.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,381.76
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$8,764.43
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$6,723.24 |
| Max. Negotiated Rate |
$8,764.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,723.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,764.43
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID [1562]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 395266216
|
| Hospital Charge Code |
NDG1562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID [1562]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 395266216
|
| Hospital Charge Code |
NDG1562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$8,890.35
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$6,819.83 |
| Max. Negotiated Rate |
$8,890.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,819.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,890.35
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$16,459.49
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$12,626.16 |
| Max. Negotiated Rate |
$16,459.49 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,626.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,459.49
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$7,517.69
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$5,766.86 |
| Max. Negotiated Rate |
$7,517.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,766.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,517.69
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$11,082.36
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$8,501.34 |
| Max. Negotiated Rate |
$11,082.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,501.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,082.36
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$121,380.93
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$93,111.95 |
| Max. Negotiated Rate |
$121,380.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93,111.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121,380.93
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$246,596.06
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$189,165.14 |
| Max. Negotiated Rate |
$246,596.06 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189,165.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246,596.06
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$43,332.73
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$33,240.77 |
| Max. Negotiated Rate |
$43,332.73 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,240.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,332.73
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$64,295.01
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$49,321.04 |
| Max. Negotiated Rate |
$64,295.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49,321.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64,295.01
|
|
|
CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION [25518]
|
Facility
|
OP
|
$58.38
|
|
|
Service Code
|
CPT J0720
|
| Hospital Charge Code |
ERX25518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$301.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$301.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.33
|
| Rate for Payer: Blue Distinction Transplant |
$35.03
|
| Rate for Payer: Blue Shield of California Commercial |
$43.03
|
| Rate for Payer: Blue Shield of California EPN |
$46.70
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cigna of CA HMO |
$40.87
|
| Rate for Payer: Cigna of CA PPO |
$40.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.62
|
| Rate for Payer: Dignity Health Media |
$49.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$46.70
|
| Rate for Payer: Networks By Design Commercial |
$29.19
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.19
|
| Rate for Payer: United Healthcare All Other HMO |
$29.19
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.62
|
|
|
CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION [25518]
|
Facility
|
IP
|
$58.38
|
|
|
Service Code
|
CPT J0720
|
| Hospital Charge Code |
ERX25518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Blue Shield of California Commercial |
$41.57
|
| Rate for Payer: Blue Shield of California EPN |
$29.89
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cigna of CA HMO |
$40.87
|
| Rate for Payer: Cigna of CA PPO |
$40.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$46.70
|
| Rate for Payer: Networks By Design Commercial |
$29.19
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.04
|
| Rate for Payer: United Healthcare All Other HMO |
$21.53
|
| Rate for Payer: United Healthcare HMO Rider |
$21.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.27
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0555-0033-05
|
| Hospital Charge Code |
1730119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$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: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| 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: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0555-0033-05
|
| Hospital Charge Code |
1730119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| 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 |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| 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 |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0033-02
|
| Hospital Charge Code |
1730119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0033-02
|
| Hospital Charge Code |
1730119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
