|
CITRULLINE 600 MG CAPSULE [13319]
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
NDC 53335-00689
|
| Hospital Charge Code |
1712162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.28
|
| Rate for Payer: BCBS Transplant Transplant |
$45.60
|
| Rate for Payer: Blue Shield of California Commercial |
$56.01
|
| Rate for Payer: Blue Shield of California EPN |
$44.38
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Media |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.00
|
| Rate for Payer: United Healthcare HMO Rider |
$38.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
CITRULLINE POWDER. [40819153]
|
Facility
IP
|
$6.48
|
|
|
Service Code
|
NDC 6299127531
|
| Hospital Charge Code |
NDG19153
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$4.54
|
| Rate for Payer: Cigna of CA PPO |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
|
|
CITRULLINE POWDER. [40819153]
|
Facility
OP
|
$6.48
|
|
|
Service Code
|
NDC 6299127531
|
| Hospital Charge Code |
NDG19153
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.86
|
| Rate for Payer: BCBS Transplant Transplant |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.78
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$4.54
|
| Rate for Payer: Cigna of CA PPO |
$4.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.51
|
| Rate for Payer: Dignity Health Media |
$5.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]
|
Facility
IP
|
$52.20
|
|
|
Service Code
|
CPT J9065
|
| Hospital Charge Code |
1755613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cigna of CA HMO |
$36.54
|
| Rate for Payer: Cigna of CA PPO |
$36.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.88
|
| Rate for Payer: Galaxy Health WC |
$44.37
|
| Rate for Payer: Global Benefits Group Commercial |
$31.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$41.76
|
| Rate for Payer: Networks By Design Commercial |
$26.10
|
| Rate for Payer: Prime Health Services Commercial |
$44.37
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]
|
Facility
OP
|
$52.20
|
|
|
Service Code
|
CPT J9065
|
| Hospital Charge Code |
1755613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$110.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.11
|
| Rate for Payer: BCBS Transplant Transplant |
$31.32
|
| Rate for Payer: Blue Shield of California Commercial |
$38.47
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cigna of CA HMO |
$36.54
|
| Rate for Payer: Cigna of CA PPO |
$36.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.66
|
| Rate for Payer: Dignity Health Media |
$15.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.77
|
| Rate for Payer: Galaxy Health WC |
$44.37
|
| Rate for Payer: Global Benefits Group Commercial |
$31.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$25.87
|
| Rate for Payer: IEHP Medi-Cal |
$25.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$25.55
|
| Rate for Payer: IEHP Medicare Advantage |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$41.76
|
| Rate for Payer: Networks By Design Commercial |
$26.10
|
| Rate for Payer: Prime Health Services Commercial |
$44.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.10
|
| Rate for Payer: United Healthcare All Other HMO |
$26.10
|
| Rate for Payer: United Healthcare HMO Rider |
$26.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15.77
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
NDC 0781-6022-46
|
| Hospital Charge Code |
NDG12285
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
IP
|
$1.41
|
|
|
Service Code
|
NDC 0781-6022-52
|
| Hospital Charge Code |
1715982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.20
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
NDC 0781-6022-46
|
| Hospital Charge Code |
NDG12285
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Media |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
OP
|
$1.41
|
|
|
Service Code
|
NDC 0781-6022-52
|
| Hospital Charge Code |
1715982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Galaxy Health WC |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.20
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]
|
Facility
IP
|
$2.06
|
|
|
Service Code
|
NDC 0781-6023-52
|
| Hospital Charge Code |
1715955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]
|
Facility
OP
|
$2.06
|
|
|
Service Code
|
NDC 0781-6023-52
|
| Hospital Charge Code |
1715955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: BCBS Transplant Transplant |
$1.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Media |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1961-60
|
| Hospital Charge Code |
1711631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Media |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1961-60
|
| Hospital Charge Code |
1711631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1962-60
|
| Hospital Charge Code |
1711531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1962-60
|
| Hospital Charge Code |
1711531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Media |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$12,623.49
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$9,683.54 |
| Max. Negotiated Rate |
$12,623.49 |
| Rate for Payer: IEHP Medi-Cal |
$9,683.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,623.49
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$23,560.42
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$18,073.32 |
| Max. Negotiated Rate |
$23,560.42 |
| Rate for Payer: IEHP Medi-Cal |
$18,073.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,560.42
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$33,635.43
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$25,801.92 |
| Max. Negotiated Rate |
$33,635.43 |
| Rate for Payer: IEHP Medi-Cal |
$25,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,635.43
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$14,579.61
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$11,184.10 |
| Max. Negotiated Rate |
$14,579.61 |
| Rate for Payer: IEHP Medi-Cal |
$11,184.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,579.61
|
|
|
CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]
|
Facility
IP
|
$1.99
|
|
|
Service Code
|
CPT C9248
|
| Hospital Charge Code |
NDG93936
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
|
|
CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]
|
Facility
OP
|
$1.99
|
|
|
Service Code
|
CPT C9248
|
| Hospital Charge Code |
NDG93936
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.89
|
| Rate for Payer: BCBS Transplant Transplant |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Media |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
NDG1743A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.12
|
| Rate for Payer: IEHP Medi-Cal |
$3.08
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.08
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1721155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: BCBS Transplant Transplant |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$0.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.12
|
| Rate for Payer: IEHP Medi-Cal |
$3.08
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.08
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$1.27
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1720473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.12
|
| Rate for Payer: IEHP Medi-Cal |
$3.08
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.08
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
NDG1743A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
