|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
OP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.59
|
| Rate for Payer: BCBS Transplant Transplant |
$14.69
|
| Rate for Payer: Blue Shield of California Commercial |
$18.04
|
| Rate for Payer: Blue Shield of California EPN |
$14.30
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.81
|
| Rate for Payer: Dignity Health Media |
$20.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other HMO |
$12.24
|
| Rate for Payer: United Healthcare HMO Rider |
$12.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.81
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
IP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California EPN |
$12.53
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
IP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
NDC4081161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Blue Shield of California Commercial |
$26.02
|
| Rate for Payer: Blue Shield of California EPN |
$18.71
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
OP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
NDC4081161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.77
|
| Rate for Payer: BCBS Transplant Transplant |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$26.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.34
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.06
|
| Rate for Payer: Dignity Health Media |
$31.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.06
|
| Rate for Payer: Vantage Medical Group Senior |
$31.06
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
OP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
NDC4081092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.77
|
| Rate for Payer: BCBS Transplant Transplant |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$26.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.34
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.06
|
| Rate for Payer: Dignity Health Media |
$31.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.06
|
| Rate for Payer: Vantage Medical Group Senior |
$31.06
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
IP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
NDC4081092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Blue Shield of California Commercial |
$26.02
|
| Rate for Payer: Blue Shield of California EPN |
$18.71
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
|
|
CIDOFOVIR 3 MG/ML TOPICAL [4081091]
|
Facility
IP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-91
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Blue Shield of California Commercial |
$26.02
|
| Rate for Payer: Blue Shield of California EPN |
$18.71
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
|
|
CIDOFOVIR 3 MG/ML TOPICAL [4081091]
|
Facility
OP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-91
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.77
|
| Rate for Payer: BCBS Transplant Transplant |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$26.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.34
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.06
|
| Rate for Payer: Dignity Health Media |
$31.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.06
|
| Rate for Payer: Vantage Medical Group Senior |
$31.06
|
|
|
CIDOFOVIR 5 MG/ML TOPICAL [4081159]
|
Facility
IP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-59
|
| Hospital Charge Code |
NDC4081159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Blue Shield of California Commercial |
$26.02
|
| Rate for Payer: Blue Shield of California EPN |
$18.71
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$23.75
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
|
|
CIDOFOVIR 5 MG/ML TOPICAL [4081159]
|
Facility
OP
|
$36.54
|
|
|
Service Code
|
NDC 99994-811-59
|
| Hospital Charge Code |
NDC4081159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.77
|
| Rate for Payer: BCBS Transplant Transplant |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$26.93
|
| Rate for Payer: Blue Shield of California EPN |
$21.34
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$25.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.06
|
| Rate for Payer: Dignity Health Media |
$31.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.06
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: Networks By Design Commercial |
$23.75
|
| Rate for Payer: Prime Health Services Commercial |
$31.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.06
|
| Rate for Payer: Vantage Medical Group Senior |
$31.06
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
CPT J0740
|
| Hospital Charge Code |
1757059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$3,485.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,485.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$609.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$609.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,502.82
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$130.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,037.23
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$831.29
|
| Rate for Payer: Dignity Health Media |
$554.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$609.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$554.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$554.19
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$908.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$908.87
|
| Rate for Payer: IEHP Medi-Cal |
$897.79
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$897.79
|
| Rate for Payer: IEHP Medicare Advantage |
$554.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$698.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$742.62
|
| Rate for Payer: Multiplan Commercial |
$142.08
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$831.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$609.61
|
| Rate for Payer: Vantage Medical Group Senior |
$554.19
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
CPT J0740
|
| Hospital Charge Code |
1757059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Blue Shield of California Commercial |
$126.45
|
| Rate for Payer: Blue Shield of California EPN |
$90.93
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.62
|
| Rate for Payer: Multiplan Commercial |
$142.08
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
IP
|
$0.43
|
|
|
Service Code
|
NDC 0054-0044-21
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 0185-0223-60
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| 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: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| 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
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0093-2064-06
|
| Hospital Charge Code |
1710971
|
|
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
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
IP
|
$0.43
|
|
|
Service Code
|
NDC 0054-0044-29
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 0185-0223-60
|
| Hospital Charge Code |
1710971
|
|
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
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
OP
|
$0.43
|
|
|
Service Code
|
NDC 0054-0044-21
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| 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 |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| 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 |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| 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 |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| 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
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0093-2064-06
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| 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: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| 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
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
OP
|
$0.43
|
|
|
Service Code
|
NDC 0054-0044-29
|
| Hospital Charge Code |
1710971
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| 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: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| 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 |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| 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 |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| 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
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 16729-440-10
|
| Hospital Charge Code |
ERX40820825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
ERX40820825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 16729-440-10
|
| Hospital Charge Code |
ERX40820825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
ERX40820825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
NDC 67877-503-30
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Media |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
