|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6050525316
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 6808410611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Senior |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO |
$1.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2.82
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 6808410609
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Senior |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.82
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 6808410611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Senior |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.82
|
|
|
ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.54
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.54
|
|
|
ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$243.36
|
| Rate for Payer: Blue Shield of California Commercial |
$369.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.54
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.54
|
|
|
ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$243.36
|
| Rate for Payer: Blue Shield of California Commercial |
$369.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
ZOLBETUXIMAB-CLZB 100 MG INTRAVENOUS SOLUTION [243165]
|
Facility
|
IP
|
$1,939.20
|
|
|
Service Code
|
HCPCS J1326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$387.84 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Adventist Health Commercial |
$387.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,491.24
|
| Rate for Payer: Blue Shield of California Commercial |
$983.17
|
| Rate for Payer: Cash Price |
$872.64
|
| Rate for Payer: Cigna of CA HMO |
$1,357.44
|
| Rate for Payer: Cigna of CA PPO |
$1,357.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.68
|
| Rate for Payer: EPIC Health Plan Senior |
$775.68
|
| Rate for Payer: Galaxy Health WC |
$1,648.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,144.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.41
|
| Rate for Payer: Multiplan Commercial |
$1,551.36
|
| Rate for Payer: Networks By Design Commercial |
$969.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.78
|
| Rate for Payer: United Healthcare All Other HMO |
$708.39
|
| Rate for Payer: United Healthcare HMO Rider |
$693.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.09
|
|
|
ZOLBETUXIMAB-CLZB 100 MG INTRAVENOUS SOLUTION [243165]
|
Facility
|
OP
|
$1,939.20
|
|
|
Service Code
|
HCPCS J1326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Adventist Health Commercial |
$387.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,271.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.40
|
| Rate for Payer: Cash Price |
$872.64
|
| Rate for Payer: Cash Price |
$872.64
|
| Rate for Payer: Cigna of CA HMO |
$1,357.44
|
| Rate for Payer: Cigna of CA PPO |
$1,357.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.97
|
| Rate for Payer: EPIC Health Plan Senior |
$37.31
|
| Rate for Payer: Galaxy Health WC |
$1,648.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$55.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.45
|
| Rate for Payer: Multiplan Commercial |
$1,551.36
|
| Rate for Payer: Networks By Design Commercial |
$969.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,163.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.78
|
| Rate for Payer: United Healthcare All Other HMO |
$708.39
|
| Rate for Payer: United Healthcare HMO Rider |
$693.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.31
|
| Rate for Payer: Vantage Medical Group Senior |
$33.92
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO |
$30.24
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$30.24
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$36.72
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$25.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$36.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.78
|
| Rate for Payer: United Healthcare HMO Rider |
$15.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.72
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$36.72
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]
|
Facility
|
IP
|
$43.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$33.22
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO |
$30.24
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$30.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$36.72
|
| Rate for Payer: Global Benefits Group Commercial |
$25.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$34.56
|
| Rate for Payer: Networks By Design Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$36.72
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.21
|
| Rate for Payer: United Healthcare All Other HMO |
$15.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.15
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 1366800801
|
| 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: 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| 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 |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| 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 |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6586216001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| 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 |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6586216001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| 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 Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 1366800801
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| 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 |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 6068783801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 6068783801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 6068783811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0904608261
|
| 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 |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0781531701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
