|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 65862-019-05
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
OP
|
$0.53
|
|
|
Service Code
|
NDC 50268-152-15
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Media |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 60687-163-01
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 0093-3147-05
|
| Hospital Charge Code |
1710148
|
|
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 500 MG CAPSULE [9500]
|
Facility
OP
|
$0.53
|
|
|
Service Code
|
NDC 50268-152-11
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Media |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 68180-122-01
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 0093-3147-01
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| 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 |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
CEPHALEXIN 500 MG CAPSULE [9500]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 68180-122-02
|
| Hospital Charge Code |
1710148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 600053797
|
| Hospital Charge Code |
ERX118075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 600053797
|
| Hospital Charge Code |
ERX118075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 600053772
|
| Hospital Charge Code |
NDG118075A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 600053772
|
| Hospital Charge Code |
NDG118075A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
Cerclage of cervix, during pregnancy; vaginal
|
Facility
OP
|
$7,282.00
|
|
|
Service Code
|
CPT 59320
|
| Min. Negotiated Rate |
$245.82 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$6,328.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
IP
|
$6,480.67
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
ERX4081378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,555.36 |
| Max. Negotiated Rate |
$5,508.57 |
| Rate for Payer: Blue Shield of California Commercial |
$4,614.24
|
| Rate for Payer: Blue Shield of California EPN |
$3,318.10
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cigna of CA HMO |
$4,536.47
|
| Rate for Payer: Cigna of CA PPO |
$4,536.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,592.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,592.27
|
| Rate for Payer: Galaxy Health WC |
$5,508.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3,888.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,322.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,469.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,555.36
|
| Rate for Payer: Multiplan Commercial |
$5,184.54
|
| Rate for Payer: Networks By Design Commercial |
$3,240.34
|
| Rate for Payer: Prime Health Services Commercial |
$5,508.57
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
OP
|
$6,480.67
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
ERX4081378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$5,508.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.40
|
| Rate for Payer: BCBS Transplant Transplant |
$3,888.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,776.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cigna of CA HMO |
$4,536.47
|
| Rate for Payer: Cigna of CA PPO |
$4,536.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Media |
$4.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$5,508.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3,888.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,860.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.90
|
| Rate for Payer: IEHP Medi-Cal |
$7.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.80
|
| Rate for Payer: IEHP Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,322.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,555.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$5,184.54
|
| Rate for Payer: Networks By Design Commercial |
$3,240.34
|
| Rate for Payer: Prime Health Services Commercial |
$5,508.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,888.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,888.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,240.34
|
| Rate for Payer: United Healthcare All Other HMO |
$3,240.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3,240.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,240.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
Cesarean delivery only;
|
Facility
OP
|
$10,541.00
|
|
|
Service Code
|
CPT 59514
|
| Min. Negotiated Rate |
$1,034.97 |
| Max. Negotiated Rate |
$10,541.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,183.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,541.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,034.97
|
|
|
Cesarean delivery only; including postpartum care
|
Facility
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 59515
|
| Min. Negotiated Rate |
$10,541.00 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,541.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$14,409.37
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$11,053.51 |
| Max. Negotiated Rate |
$14,409.37 |
| Rate for Payer: IEHP Medi-Cal |
$11,053.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,409.37
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$9,358.54
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$7,178.99 |
| Max. Negotiated Rate |
$9,358.54 |
| Rate for Payer: IEHP Medi-Cal |
$7,178.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,358.54
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$11,399.81
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$8,744.85 |
| Max. Negotiated Rate |
$11,399.81 |
| Rate for Payer: IEHP Medi-Cal |
$8,744.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,399.81
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$26,634.35
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$20,431.35 |
| Max. Negotiated Rate |
$26,634.35 |
| Rate for Payer: IEHP Medi-Cal |
$20,431.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,634.35
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$9,537.68
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$7,316.40 |
| Max. Negotiated Rate |
$9,537.68 |
| Rate for Payer: IEHP Medi-Cal |
$7,316.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,537.68
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$11,016.73
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$8,450.99 |
| Max. Negotiated Rate |
$11,016.73 |
| Rate for Payer: IEHP Medi-Cal |
$8,450.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,016.73
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$15,569.21
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$11,943.22 |
| Max. Negotiated Rate |
$15,569.21 |
| Rate for Payer: IEHP Medi-Cal |
$11,943.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,569.21
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$35,440.30
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$27,186.44 |
| Max. Negotiated Rate |
$35,440.30 |
| Rate for Payer: IEHP Medi-Cal |
$27,186.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,440.30
|
|
