|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$11.15
|
|
|
Service Code
|
NDC 60687-389-11
|
| Hospital Charge Code |
1710835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Blue Shield of California Commercial |
$7.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.71
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$7.80
|
| Rate for Payer: Cigna of CA PPO |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Galaxy Health WC |
$9.48
|
| Rate for Payer: Global Benefits Group Commercial |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
| Rate for Payer: Networks By Design Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$9.48
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 65162-710-03
|
| Hospital Charge Code |
1710835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Blue Distinction Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Media |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0254-2008-01
|
| Hospital Charge Code |
1710835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Blue Shield of California Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.73
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Networks By Design Commercial |
$4.38
|
| Rate for Payer: Prime Health Services Commercial |
$5.73
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 67877-589-01
|
| Hospital Charge Code |
1710835
|
|
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
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 0591-2562-30
|
| Hospital Charge Code |
1710835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Blue Distinction Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Media |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
NDC 50268-187-11
|
| Hospital Charge Code |
1710835
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
COLESEVELAM 625 MG TABLET [28372]
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 65597-701-18
|
| Hospital Charge Code |
1711885
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$3.12
|
| Rate for Payer: Cigna of CA PPO |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$3.79
|
|
|
COLESEVELAM 625 MG TABLET [28372]
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 65597-701-18
|
| Hospital Charge Code |
1711885
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.66
|
| Rate for Payer: Blue Distinction Transplant |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$3.12
|
| Rate for Payer: Cigna of CA PPO |
$3.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.79
|
| Rate for Payer: Dignity Health Media |
$3.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$3.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.23
|
| Rate for Payer: United Healthcare All Other HMO |
$2.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.79
|
| Rate for Payer: Vantage Medical Group Senior |
$3.79
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 0115-5211-16
|
| Hospital Charge Code |
1711918
|
|
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 |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| 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 |
$0.83
|
| 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 |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 59762-0450-1
|
| Hospital Charge Code |
1711918
|
|
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
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 0115-5211-16
|
| Hospital Charge Code |
1711918
|
|
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 |
$0.74
|
| 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 |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| 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 |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| 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 |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| 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 |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| 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
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 59762-0450-1
|
| Hospital Charge Code |
1711918
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Distinction 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) 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: 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
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
ERX12218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
ERX12218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.25
|
| Rate for Payer: Blue Distinction Transplant |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Media |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4080399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$101.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.27
|
| Rate for Payer: Blue Distinction Transplant |
$20.16
|
| Rate for Payer: Blue Distinction Transplant |
$20.15
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
IP
|
$33.59
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4080399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.55 |
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.69
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.12
|
| Rate for Payer: United Healthcare HMO Rider |
$12.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.09
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
IP
|
$33.59
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4082134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.55 |
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.69
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.12
|
| Rate for Payer: United Healthcare HMO Rider |
$12.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.09
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
CPT J0770
|
| Hospital Charge Code |
ERX4082134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$101.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.27
|
| Rate for Payer: Blue Distinction Transplant |
$20.16
|
| Rate for Payer: Blue Distinction Transplant |
$20.15
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$11.52
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
1743273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Blue Shield of California Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$10.95
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
NDG9682B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Blue Shield of California Commercial |
$7.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.61
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$9.31
|
| Rate for Payer: Global Benefits Group Commercial |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$7.12
|
| Rate for Payer: Prime Health Services Commercial |
$9.31
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$11.52
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
1743273
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.86
|
| Rate for Payer: Blue Distinction Transplant |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California EPN |
$6.73
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Media |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$7.49
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$10.95
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
NDG9682B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.52
|
| Rate for Payer: Blue Distinction Transplant |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.31
|
| Rate for Payer: Dignity Health Media |
$9.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$9.31
|
| Rate for Payer: Global Benefits Group Commercial |
$6.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: Networks By Design Commercial |
$7.12
|
| Rate for Payer: Prime Health Services Commercial |
$9.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$9.31
|
|
|
COMPOUNDING VEHICLE (FLAVOR SWEET) NO 8 ORAL LIQUID [37965]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$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 |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
COMPOUNDING VEHICLE (FLAVOR SWEET) NO 8 ORAL LIQUID [37965]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE (ORA-PLUS) SUSPENSION SUGAR-FREE NO.20 ORAL [211818]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030316
|
| Hospital Charge Code |
NDG211818
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
