|
AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION [365]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0121-0646-16
|
| Hospital Charge Code |
1715916
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0802-5
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.34
|
| Rate for Payer: Blue Distinction Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$331.93
|
| Rate for Payer: Blue Shield of California EPN |
$263.02
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: Dignity Health Media |
$382.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$337.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
OP
|
$46.08
|
|
|
Service Code
|
NDC 47335-237-83
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.45
|
| Rate for Payer: Blue Distinction Transplant |
$27.65
|
| Rate for Payer: Blue Shield of California Commercial |
$33.96
|
| Rate for Payer: Blue Shield of California EPN |
$26.91
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cigna of CA HMO |
$32.26
|
| Rate for Payer: Cigna of CA PPO |
$32.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.17
|
| Rate for Payer: Dignity Health Media |
$39.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO |
$23.04
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.17
|
| Rate for Payer: Vantage Medical Group Senior |
$39.17
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
IP
|
$46.08
|
|
|
Service Code
|
NDC 47335-237-83
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Blue Shield of California Commercial |
$32.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.59
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cigna of CA HMO |
$32.26
|
| Rate for Payer: Cigna of CA PPO |
$32.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
IP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0802-5
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Blue Shield of California Commercial |
$320.67
|
| Rate for Payer: Blue Shield of California EPN |
$230.59
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
IP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0802-1
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Blue Shield of California Commercial |
$320.67
|
| Rate for Payer: Blue Shield of California EPN |
$230.59
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
|
|
AMBRISENTAN 10 MG TABLET [82308]
|
Facility
|
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0802-1
|
| Hospital Charge Code |
1712539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.34
|
| Rate for Payer: Blue Distinction Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$331.93
|
| Rate for Payer: Blue Shield of California EPN |
$263.02
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: Dignity Health Media |
$382.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$337.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-5
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.34
|
| Rate for Payer: Blue Distinction Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$331.93
|
| Rate for Payer: Blue Shield of California EPN |
$263.02
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: Dignity Health Media |
$382.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$337.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
IP
|
$46.08
|
|
|
Service Code
|
NDC 47335-236-83
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Blue Shield of California Commercial |
$32.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.59
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cigna of CA HMO |
$32.26
|
| Rate for Payer: Cigna of CA PPO |
$32.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-1
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.34
|
| Rate for Payer: Blue Distinction Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$331.93
|
| Rate for Payer: Blue Shield of California EPN |
$263.02
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: Dignity Health Media |
$382.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$337.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
IP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-1
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Blue Shield of California Commercial |
$320.67
|
| Rate for Payer: Blue Shield of California EPN |
$230.59
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
IP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-5
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Blue Shield of California Commercial |
$320.67
|
| Rate for Payer: Blue Shield of California EPN |
$230.59
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.09
|
| Rate for Payer: Multiplan Commercial |
$360.30
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
|
OP
|
$46.08
|
|
|
Service Code
|
NDC 47335-236-83
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.45
|
| Rate for Payer: Blue Distinction Transplant |
$27.65
|
| Rate for Payer: Blue Shield of California Commercial |
$33.96
|
| Rate for Payer: Blue Shield of California EPN |
$26.91
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cigna of CA HMO |
$32.26
|
| Rate for Payer: Cigna of CA PPO |
$32.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.17
|
| Rate for Payer: Dignity Health Media |
$39.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO |
$23.04
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.17
|
| Rate for Payer: Vantage Medical Group Senior |
$39.17
|
|
|
AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [121296]
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1752069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$12.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$2.88
|
| Rate for Payer: Blue Distinction Transplant |
$2.79
|
| Rate for Payer: Blue Distinction Transplant |
$1.31
|
| Rate for Payer: Blue Distinction Transplant |
$4.41
|
| Rate for Payer: Blue Distinction Transplant |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$4.89
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$4.89
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Media |
$1.86
|
| Rate for Payer: Dignity Health Media |
$5.94
|
| Rate for Payer: Dignity Health Media |
$6.25
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Media |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.86
|
| Rate for Payer: Galaxy Health WC |
$5.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$5.59
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1.86
|
|
|
AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [121296]
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1752069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$4.89
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$4.89
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$5.94
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.86
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$4.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1.77
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION [121291]
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1720006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$12.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$4.41
|
| Rate for Payer: Blue Distinction Transplant |
$2.88
|
| Rate for Payer: Blue Distinction Transplant |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.25
|
| Rate for Payer: Dignity Health Media |
$4.08
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Media |
$6.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$3.72
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION [121291]
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1720006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
|
|
AMILORIDE 5 MG TABLET [391]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0574-0292-01
|
| Hospital Charge Code |
1710531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
AMILORIDE 5 MG TABLET [391]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0574-0292-01
|
| Hospital Charge Code |
1710531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
AMINO ACID INFUSION 7 % INTRAVENOUS SOLUTION [4089055]
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 9994-0890-55
|
| Hospital Charge Code |
NDC4089055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$206.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.68
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$232.16
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO |
$157.50
|
| Rate for Payer: United Healthcare HMO Rider |
$157.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
AMINO ACID INFUSION 7 % INTRAVENOUS SOLUTION [4089055]
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 9994-0890-55
|
| Hospital Charge Code |
NDC4089055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Blue Shield of California Commercial |
$224.28
|
| Rate for Payer: Blue Shield of California EPN |
$161.28
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 49411-052-08
|
| Hospital Charge Code |
NDG9062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.45
|
| Rate for Payer: Blue Distinction Transplant |
$8.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10.45
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$9.93
|
| Rate for Payer: Cigna of CA PPO |
$9.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.05
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 49411-052-08
|
| Hospital Charge Code |
NDG9062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Blue Shield of California Commercial |
$10.10
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$9.93
|
| Rate for Payer: Cigna of CA PPO |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.05
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
CPT S0017
|
| Hospital Charge Code |
1720161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.70
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$0.20
|
| 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) Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.29
|
| 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 |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| 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
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
CPT S0017
|
| Hospital Charge Code |
1720161
|
|
Hospital Revenue Code
|
636
|
| 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: 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: 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 |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
|
