|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 42195-955-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 51672-4222-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 43547-686-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 70010-044-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| 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 |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| 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 |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 43547-686-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 70010-044-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
OP
|
$31.13
|
|
|
Service Code
|
NDC 60505-0813-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.12
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$21.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.45
|
| Rate for Payer: EPIC Health Plan Senior |
$12.45
|
| Rate for Payer: Galaxy Health WC |
$26.46
|
| Rate for Payer: Global Benefits Group Commercial |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$24.90
|
| Rate for Payer: Networks By Design Commercial |
$20.23
|
| Rate for Payer: Prime Health Services Commercial |
$26.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.56
|
| Rate for Payer: United Healthcare All Other HMO |
$15.56
|
| Rate for Payer: United Healthcare HMO Rider |
$15.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.46
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
IP
|
$31.13
|
|
|
Service Code
|
NDC 60505-0813-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California EPN |
$15.13
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$21.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.45
|
| Rate for Payer: EPIC Health Plan Senior |
$12.45
|
| Rate for Payer: Galaxy Health WC |
$26.46
|
| Rate for Payer: Global Benefits Group Commercial |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$24.90
|
| Rate for Payer: Networks By Design Commercial |
$20.23
|
| Rate for Payer: Prime Health Services Commercial |
$26.46
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
OP
|
$13.61
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cigna of CA HMO |
$9.53
|
| Rate for Payer: Cigna of CA PPO |
$9.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$10.89
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.97
|
| Rate for Payer: United Healthcare HMO Rider |
$4.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
IP
|
$13.61
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cigna of CA HMO |
$9.53
|
| Rate for Payer: Cigna of CA PPO |
$9.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$10.89
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.97
|
| Rate for Payer: United Healthcare HMO Rider |
$4.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
OP
|
$11.72
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$8.20
|
| Rate for Payer: Cigna of CA PPO |
$8.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$9.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$7.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$9.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$7.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$9.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$8.20
|
| Rate for Payer: Cigna of CA PPO |
$8.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$4.69
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$9.96
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 9994-0806-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.21
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 9994-0806-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
OP
|
$5.59
|
|
|
Service Code
|
NDC 9994-0819-52
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.43
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.47
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
IP
|
$5.59
|
|
|
Service Code
|
NDC 9994-0819-52
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.47
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.75
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
NDC 0093-5420-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 0093-5420-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.61
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$5.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6.38
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 50742-118-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
NDC 23155-823-73
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.50
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 50742-118-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.30
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 23155-823-73
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.89
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 4601701816
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
