|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.18
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Blue Shield of California Commercial |
$146.83
|
| Rate for Payer: Blue Shield of California EPN |
$96.69
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Adventist Health Commercial |
$21.65
|
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.29
|
| Rate for Payer: Blue Shield of California Commercial |
$92.92
|
| Rate for Payer: Blue Shield of California Commercial |
$72.41
|
| Rate for Payer: Blue Shield of California EPN |
$61.39
|
| Rate for Payer: Blue Shield of California EPN |
$47.84
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna of CA HMO |
$69.27
|
| Rate for Payer: Cigna of CA HMO |
$88.89
|
| Rate for Payer: Cigna of CA PPO |
$102.78
|
| Rate for Payer: Cigna of CA PPO |
$80.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Global Benefits Group Commercial |
$64.94
|
| Rate for Payer: Global Benefits Group Commercial |
$83.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$86.59
|
| Rate for Payer: Multiplan Commercial |
$111.11
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Networks By Design Commercial |
$70.36
|
| Rate for Payer: Prime Health Services Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Adventist Health Commercial |
$21.65
|
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.56
|
| Rate for Payer: EPIC Health Plan Senior |
$43.30
|
| Rate for Payer: EPIC Health Plan Senior |
$55.56
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Galaxy Health WC |
$92.00
|
| Rate for Payer: Global Benefits Group Commercial |
$83.33
|
| Rate for Payer: Global Benefits Group Commercial |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.98
|
| Rate for Payer: Multiplan Commercial |
$111.11
|
| Rate for Payer: Multiplan Commercial |
$86.59
|
| Rate for Payer: Networks By Design Commercial |
$70.36
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
| Rate for Payer: Prime Health Services Commercial |
$92.00
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
OP
|
$263.98
|
|
|
Service Code
|
NDC 51144-002-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$224.38 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.11
|
| Rate for Payer: Cash Price |
$145.19
|
| Rate for Payer: Cigna of CA HMO |
$184.79
|
| Rate for Payer: Cigna of CA PPO |
$184.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.59
|
| Rate for Payer: EPIC Health Plan Senior |
$105.59
|
| Rate for Payer: Galaxy Health WC |
$224.38
|
| Rate for Payer: Global Benefits Group Commercial |
$158.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.79
|
| Rate for Payer: Multiplan Commercial |
$211.18
|
| Rate for Payer: Networks By Design Commercial |
$171.59
|
| Rate for Payer: Prime Health Services Commercial |
$224.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.99
|
| Rate for Payer: United Healthcare All Other HMO |
$131.99
|
| Rate for Payer: United Healthcare HMO Rider |
$131.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.38
|
| Rate for Payer: Vantage Medical Group Senior |
$224.38
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
IP
|
$263.98
|
|
|
Service Code
|
NDC 51144-002-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$224.38 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$194.82
|
| Rate for Payer: Blue Shield of California EPN |
$128.29
|
| Rate for Payer: Cash Price |
$145.19
|
| Rate for Payer: Cigna of CA HMO |
$184.79
|
| Rate for Payer: Cigna of CA PPO |
$184.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.59
|
| Rate for Payer: EPIC Health Plan Senior |
$105.59
|
| Rate for Payer: Galaxy Health WC |
$224.38
|
| Rate for Payer: Global Benefits Group Commercial |
$158.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.18
|
| Rate for Payer: Networks By Design Commercial |
$171.59
|
| Rate for Payer: Prime Health Services Commercial |
$224.38
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
|
IP
|
$131.28
|
|
|
Service Code
|
NDC 51144-001-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$111.59 |
| Rate for Payer: Adventist Health Commercial |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$96.88
|
| Rate for Payer: Blue Shield of California EPN |
$63.80
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Cigna of CA HMO |
$91.90
|
| Rate for Payer: Cigna of CA PPO |
$91.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.51
|
| Rate for Payer: EPIC Health Plan Senior |
$52.51
|
| Rate for Payer: Galaxy Health WC |
$111.59
|
| Rate for Payer: Global Benefits Group Commercial |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.51
|
| Rate for Payer: Multiplan Commercial |
$105.02
|
| Rate for Payer: Networks By Design Commercial |
$85.33
|
| Rate for Payer: Prime Health Services Commercial |
$111.59
|
|
|
TUCATINIB 50 MG TABLET [227736]
|
Facility
|
OP
|
$131.28
|
|
|
Service Code
|
NDC 51144-001-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$111.59 |
| Rate for Payer: Adventist Health Commercial |
$26.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.62
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Cigna of CA HMO |
$91.90
|
| Rate for Payer: Cigna of CA PPO |
$91.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.51
|
| Rate for Payer: EPIC Health Plan Senior |
$52.51
|
| Rate for Payer: Galaxy Health WC |
$111.59
|
| Rate for Payer: Global Benefits Group Commercial |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.90
|
| Rate for Payer: Multiplan Commercial |
$105.02
|
| Rate for Payer: Networks By Design Commercial |
$85.33
|
| Rate for Payer: Prime Health Services Commercial |
$111.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.64
|
| Rate for Payer: United Healthcare All Other HMO |
$65.64
|
| Rate for Payer: United Healthcare HMO Rider |
$65.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.59
|
| Rate for Payer: Vantage Medical Group Senior |
$111.59
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
|
IP
|
$369.36
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.87 |
| Max. Negotiated Rate |
$313.96 |
| Rate for Payer: Adventist Health Commercial |
$73.87
|
| Rate for Payer: Blue Shield of California Commercial |
$272.59
|
| Rate for Payer: Blue Shield of California EPN |
$179.51
|
| Rate for Payer: Cash Price |
$203.15
|
| Rate for Payer: Cigna of CA HMO |
$258.55
|
| Rate for Payer: Cigna of CA PPO |
$258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.74
|
| Rate for Payer: EPIC Health Plan Senior |
$147.74
|
| Rate for Payer: Galaxy Health WC |
$313.96
|
| Rate for Payer: Global Benefits Group Commercial |
$221.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.65
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$184.68
|
| Rate for Payer: Prime Health Services Commercial |
$313.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.62
|
| Rate for Payer: United Healthcare All Other HMO |
$134.93
|
| Rate for Payer: United Healthcare HMO Rider |
$132.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.97
|
|
|
TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE [14678]
|
Facility
|
OP
|
$369.36
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.87 |
| Max. Negotiated Rate |
$319.75 |
| Rate for Payer: Adventist Health Commercial |
$73.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.75
|
| Rate for Payer: Blue Shield of California Commercial |
$135.58
|
| Rate for Payer: Blue Shield of California EPN |
$135.58
|
| Rate for Payer: Cash Price |
$203.15
|
| Rate for Payer: Cash Price |
$203.15
|
| Rate for Payer: Cigna of CA HMO |
$258.55
|
| Rate for Payer: Cigna of CA PPO |
$258.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$313.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.74
|
| Rate for Payer: EPIC Health Plan Senior |
$147.74
|
| Rate for Payer: Galaxy Health WC |
$313.96
|
| Rate for Payer: Global Benefits Group Commercial |
$221.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$258.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$258.55
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$184.68
|
| Rate for Payer: Prime Health Services Commercial |
$313.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.62
|
| Rate for Payer: United Healthcare All Other HMO |
$134.93
|
| Rate for Payer: United Healthcare HMO Rider |
$132.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.96
|
| Rate for Payer: Vantage Medical Group Senior |
$313.96
|
|
|
UREA 10 % LOTION [19779]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5898060880
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$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
|
|
|
UREA 10 % LOTION [19779]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5898060880
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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 |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| 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
|
|
|
UREA 15 GRAM ORAL POWDER PACKET [218764]
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 6253000011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
UREA 15 GRAM ORAL POWDER PACKET [218764]
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 6253000011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
UREA 20 % TOPICAL CREAM [19776]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0536110945
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
UREA 20 % TOPICAL CREAM [19776]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 0884044904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| 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 |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
UREA 20 % TOPICAL CREAM [19776]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0536110945
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
UREA 20 % TOPICAL CREAM [19776]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 0884044904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
UREA(C14) 37 KBQ (1 MICROCI) CAPSULE [233734]
|
Facility
|
OP
|
$42.08
|
|
|
Service Code
|
HCPCS A4641
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Adventist Health Commercial |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.84
|
| Rate for Payer: Blue Shield of California Commercial |
$25.75
|
| Rate for Payer: Blue Shield of California EPN |
$17.00
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cigna of CA HMO |
$26.93
|
| Rate for Payer: Cigna of CA PPO |
$31.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$35.77
|
| Rate for Payer: Global Benefits Group Commercial |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.46
|
| Rate for Payer: Multiplan Commercial |
$33.66
|
| Rate for Payer: Networks By Design Commercial |
$27.35
|
| Rate for Payer: Prime Health Services Commercial |
$35.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.79
|
| Rate for Payer: United Healthcare All Other HMO |
$15.37
|
| Rate for Payer: United Healthcare HMO Rider |
$15.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.77
|
| Rate for Payer: Vantage Medical Group Senior |
$35.77
|
|
|
UREA(C14) 37 KBQ (1 MICROCI) CAPSULE [233734]
|
Facility
|
IP
|
$42.08
|
|
|
Service Code
|
HCPCS A4641
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Adventist Health Commercial |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$31.06
|
| Rate for Payer: Blue Shield of California EPN |
$20.45
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$35.77
|
| Rate for Payer: Global Benefits Group Commercial |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$33.66
|
| Rate for Payer: Networks By Design Commercial |
$27.35
|
| Rate for Payer: Prime Health Services Commercial |
$35.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.79
|
| Rate for Payer: United Healthcare All Other HMO |
$15.37
|
| Rate for Payer: United Healthcare HMO Rider |
$15.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.78
|
|
|
URSODIOL 250 MG TABLET [22660]
|
Facility
|
IP
|
$3.95
|
|
|
Service Code
|
NDC 0904-6890-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.36
|
| Rate for Payer: Global Benefits Group Commercial |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.36
|
|
|
URSODIOL 250 MG TABLET [22660]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 60687-527-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
URSODIOL 250 MG TABLET [22660]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 60687-527-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
URSODIOL 250 MG TABLET [22660]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 60687-527-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
URSODIOL 250 MG TABLET [22660]
|
Facility
|
OP
|
$3.95
|
|
|
Service Code
|
NDC 0904-6890-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.43
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna of CA HMO |
$2.77
|
| Rate for Payer: Cigna of CA PPO |
$2.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.36
|
| Rate for Payer: Global Benefits Group Commercial |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
| Rate for Payer: Networks By Design Commercial |
$2.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.36
|
| Rate for Payer: Vantage Medical Group Senior |
$3.36
|
|
