CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$0.12
|
|
Service Code
|
NDC 72241-024-05
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.10 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
Rate for Payer: BCBS Transplant Transplant |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.09
|
Rate for Payer: Blue Shield of California EPN |
$0.07
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.08
|
Rate for Payer: Cigna of CA PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
Rate for Payer: Dignity Health Media |
$0.10
|
Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
Rate for Payer: Galaxy Health WC |
$0.10
|
Rate for Payer: Global Benefits Group Commercial |
$0.07
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.10
|
Rate for Payer: Networks By Design Commercial |
$0.08
|
Rate for Payer: Prime Health Services Commercial |
$0.10
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
Rate for Payer: United Healthcare All Other HMO |
$0.06
|
Rate for Payer: United Healthcare HMO Rider |
$0.06
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$2.43
|
|
Service Code
|
NDC 60687-447-11
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$2.07 |
Rate for Payer: Blue Shield of California Commercial |
$1.73
|
Rate for Payer: Blue Shield of California EPN |
$1.24
|
Rate for Payer: Cash Price |
$1.09
|
Rate for Payer: Cigna of CA HMO |
$1.70
|
Rate for Payer: Cigna of CA PPO |
$1.70
|
Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
Rate for Payer: Galaxy Health WC |
$2.07
|
Rate for Payer: Global Benefits Group Commercial |
$1.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.62
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
Rate for Payer: Multiplan Commercial |
$1.94
|
Rate for Payer: Networks By Design Commercial |
$1.58
|
Rate for Payer: Prime Health Services Commercial |
$2.07
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$6.04
|
|
Service Code
|
NDC 51079-215-20
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.45 |
Max. Negotiated Rate |
$5.13 |
Rate for Payer: Blue Shield of California Commercial |
$4.30
|
Rate for Payer: Blue Shield of California EPN |
$3.09
|
Rate for Payer: Cash Price |
$2.72
|
Rate for Payer: Cigna of CA HMO |
$4.23
|
Rate for Payer: Cigna of CA PPO |
$4.23
|
Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
Rate for Payer: Galaxy Health WC |
$5.13
|
Rate for Payer: Global Benefits Group Commercial |
$3.62
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
Rate for Payer: Multiplan Commercial |
$4.83
|
Rate for Payer: Networks By Design Commercial |
$3.93
|
Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$0.72
|
|
Service Code
|
NDC 62332-142-31
|
Hospital Charge Code |
1710871
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.61 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
Rate for Payer: BCBS Transplant Transplant |
$0.43
|
Rate for Payer: Blue Shield of California Commercial |
$0.53
|
Rate for Payer: Blue Shield of California EPN |
$0.42
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Cigna of CA HMO |
$0.50
|
Rate for Payer: Cigna of CA PPO |
$0.50
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
Rate for Payer: Dignity Health Media |
$0.61
|
Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
Rate for Payer: Galaxy Health WC |
$0.61
|
Rate for Payer: Global Benefits Group Commercial |
$0.43
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.58
|
Rate for Payer: Networks By Design Commercial |
$0.47
|
Rate for Payer: Prime Health Services Commercial |
$0.61
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
Rate for Payer: United Healthcare All Other HMO |
$0.36
|
Rate for Payer: United Healthcare HMO Rider |
$0.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$25,277.12
|
|
Service Code
|
APR-DRG 3834
|
Min. Negotiated Rate |
$19,390.22 |
Max. Negotiated Rate |
$25,277.12 |
Rate for Payer: IEHP Medi-Cal |
$19,390.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,277.12
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$13,836.54
|
|
Service Code
|
APR-DRG 3833
|
Min. Negotiated Rate |
$10,614.08 |
Max. Negotiated Rate |
$13,836.54 |
Rate for Payer: IEHP Medi-Cal |
$10,614.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,836.54
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$6,785.26
|
|
Service Code
|
APR-DRG 3831
|
Min. Negotiated Rate |
$5,205.01 |
Max. Negotiated Rate |
$6,785.26 |
Rate for Payer: IEHP Medi-Cal |
$5,205.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,785.26
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$9,300.02
|
|
Service Code
|
APR-DRG 3832
|
Min. Negotiated Rate |
$7,134.10 |
Max. Negotiated Rate |
$9,300.02 |
Rate for Payer: IEHP Medi-Cal |
$7,134.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,300.02
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
IP
|
$1,680.32
|
|
Service Code
|
CPT J9119
|
Hospital Charge Code |
NDG222941
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$403.28 |
Max. Negotiated Rate |
$1,428.27 |
Rate for Payer: Blue Shield of California Commercial |
$1,196.39
|
Rate for Payer: Blue Shield of California EPN |
$860.32
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cigna of CA HMO |
$1,176.22
|
Rate for Payer: Cigna of CA PPO |
$1,176.22
|
Rate for Payer: EPIC Health Plan Commercial |
$672.13
|
Rate for Payer: EPIC Health Plan Transplant |
$672.13
|
Rate for Payer: Galaxy Health WC |
$1,428.27
|
Rate for Payer: Global Benefits Group Commercial |
$1,008.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,120.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$403.28
|
Rate for Payer: Multiplan Commercial |
$1,344.26
|
Rate for Payer: Networks By Design Commercial |
$840.16
|
Rate for Payer: Prime Health Services Commercial |
$1,428.27
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
OP
|
$1,680.32
|
|
Service Code
|
CPT J9119
|
Hospital Charge Code |
NDG222941
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$27.46 |
Max. Negotiated Rate |
$1,428.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$54.09
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.33
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.21
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.21
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.25
|
Rate for Payer: BCBS Transplant Transplant |
$1,008.19
|
Rate for Payer: Blue Shield of California Commercial |
$1,238.40
|
Rate for Payer: Blue Shield of California EPN |
$981.31
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cash Price |
$756.14
|
Rate for Payer: Cigna of CA HMO |
$1,176.22
|
Rate for Payer: Cigna of CA PPO |
$1,176.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$34.33
|
Rate for Payer: Dignity Health Media |
$30.21
|
Rate for Payer: Dignity Health Medi-Cal |
$30.21
|
Rate for Payer: EPIC Health Plan Commercial |
$37.07
|
Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.46
|
Rate for Payer: EPIC Health Plan Transplant |
$27.46
|
Rate for Payer: Galaxy Health WC |
$1,428.27
|
Rate for Payer: Global Benefits Group Commercial |
$1,008.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,260.24
|
Rate for Payer: Heritage Provider Network Commercial |
$45.04
|
Rate for Payer: Heritage Provider Network Transplant |
$45.04
|
Rate for Payer: IEHP Medi-Cal |
$44.49
|
Rate for Payer: IEHP Medi-Cal Transplant |
$44.49
|
Rate for Payer: IEHP Medicare Advantage |
$27.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,120.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.65
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
Rate for Payer: LLUH Dept of Risk Management WC |
$403.28
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.60
|
Rate for Payer: Molina Healthcare of CA Medicare |
$36.80
|
Rate for Payer: Multiplan Commercial |
$1,344.26
|
Rate for Payer: Networks By Design Commercial |
$840.16
|
Rate for Payer: Prime Health Services Commercial |
$1,428.27
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,008.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,008.19
|
Rate for Payer: United Healthcare All Other Commercial |
$840.16
|
Rate for Payer: United Healthcare All Other HMO |
$840.16
|
Rate for Payer: United Healthcare HMO Rider |
$840.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$840.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.33
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$30.21
|
Rate for Payer: Vantage Medical Group Senior |
$30.21
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
IP
|
$0.23
|
|
Service Code
|
NDC 0093-4175-73
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 68180-440-01
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
IP
|
$0.10
|
|
Service Code
|
NDC 67877-544-68
|
Hospital Charge Code |
NDG9501B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
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 |
$0.05
|
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: 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: 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
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
IP
|
$0.23
|
|
Service Code
|
NDC 68180-440-01
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 0093-4175-73
|
Hospital Charge Code |
1715596
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
OP
|
$0.10
|
|
Service Code
|
NDC 67877-544-68
|
Hospital Charge Code |
NDG9501B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
Rate for Payer: BCBS Transplant Transplant |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO |
$0.07
|
Rate for Payer: Cigna of CA PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Media |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.09
|
Rate for Payer: Global Benefits Group Commercial |
$0.06
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
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: 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
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
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
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
OP
|
$0.25
|
|
Service Code
|
NDC 0093-4177-74
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
Rate for Payer: BCBS Transplant Transplant |
$0.15
|
Rate for Payer: Blue Shield of California Commercial |
$0.18
|
Rate for Payer: Blue Shield of California EPN |
$0.15
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO |
$0.18
|
Rate for Payer: Cigna of CA PPO |
$0.18
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
Rate for Payer: Dignity Health Media |
$0.21
|
Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
Rate for Payer: Galaxy Health WC |
$0.21
|
Rate for Payer: Global Benefits Group Commercial |
$0.15
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.20
|
Rate for Payer: Networks By Design Commercial |
$0.16
|
Rate for Payer: Prime Health Services Commercial |
$0.21
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
Rate for Payer: United Healthcare All Other HMO |
$0.13
|
Rate for Payer: United Healthcare HMO Rider |
$0.13
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
IP
|
$0.25
|
|
Service Code
|
NDC 0093-4177-74
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Blue Shield of California Commercial |
$0.18
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO |
$0.18
|
Rate for Payer: Cigna of CA PPO |
$0.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Galaxy Health WC |
$0.21
|
Rate for Payer: Global Benefits Group Commercial |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.20
|
Rate for Payer: Networks By Design Commercial |
$0.16
|
Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
OP
|
$0.28
|
|
Service Code
|
NDC 0093-4177-73
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
Rate for Payer: BCBS Transplant Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
OP
|
$0.16
|
|
Service Code
|
NDC 67877-545-88
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
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: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
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 |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
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
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 67877-545-68
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
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: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
IP
|
$0.28
|
|
Service Code
|
NDC 0093-4177-73
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
OP
|
$0.16
|
|
Service Code
|
NDC 67877-545-68
|
Hospital Charge Code |
NDG9502
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
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: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
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 |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
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
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 67877-545-88
|
Hospital Charge Code |
1715604
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
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: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
CEPHALEXIN 250 MG CAPSULE [9499]
|
Facility
OP
|
$0.48
|
|
Service Code
|
NDC 50268-151-11
|
Hospital Charge Code |
1710149
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
Rate for Payer: BCBS Transplant Transplant |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
Rate for Payer: Dignity Health Media |
$0.41
|
Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.38
|
Rate for Payer: Networks By Design Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
Rate for Payer: United Healthcare All Other HMO |
$0.24
|
Rate for Payer: United Healthcare HMO Rider |
$0.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|