|
CARVEDILOL ORAL SUSPENSION COMPOUND 1.25 MG/ML [4080253]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 9994-0802-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
CARVEDILOL ORAL SUSPENSION COMPOUND 1.25 MG/ML [4080253]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 9994-0802-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 69784-713-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 57664-663-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 57664-663-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 69784-713-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 69784-714-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 69784-714-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 57664-664-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 57664-664-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]
|
Facility
|
IP
|
$85.44
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$72.62 |
| Rate for Payer: Blue Shield of California EPN |
$40.24
|
| Rate for Payer: Blue Shield of California EPN |
$41.52
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cigna of CA HMO |
$59.81
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.18
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$72.62
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Global Benefits Group Commercial |
$51.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.51
|
| Rate for Payer: Multiplan Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$68.35
|
| Rate for Payer: Networks By Design Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.07
|
| Rate for Payer: United Healthcare All Other HMO |
$31.21
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$30.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.98
|
| Rate for Payer: Adventist Health Commercial |
$17.09
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.05
|
| Rate for Payer: Blue Shield of California Commercial |
$61.11
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]
|
Facility
|
OP
|
$85.44
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$72.62 |
| Rate for Payer: Adventist Health Commercial |
$17.09
|
| Rate for Payer: Adventist Health Commercial |
$16.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Cigna of CA HMO |
$59.81
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$33.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.18
|
| Rate for Payer: Galaxy Health WC |
$72.62
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Global Benefits Group Commercial |
$51.26
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$68.35
|
| Rate for Payer: Multiplan Commercial |
$66.24
|
| Rate for Payer: Networks By Design Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Prime Health Services Commercial |
$72.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.07
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$31.21
|
| Rate for Payer: United Healthcare HMO Rider |
$30.54
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.62
|
| Rate for Payer: Vantage Medical Group Senior |
$70.38
|
| Rate for Payer: Vantage Medical Group Senior |
$72.62
|
|
|
CATH HDA TRAY 12.5FRX20CM
|
Facility
|
OP
|
$895.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$761.23 |
| Rate for Payer: Adventist Health Commercial |
$179.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.71
|
| Rate for Payer: Blue Shield of California Commercial |
$660.93
|
| Rate for Payer: Blue Shield of California EPN |
$435.25
|
| Rate for Payer: Cash Price |
$403.01
|
| Rate for Payer: Cigna of CA HMO |
$626.90
|
| Rate for Payer: Cigna of CA PPO |
$626.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$761.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$761.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.23
|
| Rate for Payer: EPIC Health Plan Senior |
$358.23
|
| Rate for Payer: Galaxy Health WC |
$761.23
|
| Rate for Payer: Global Benefits Group Commercial |
$537.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$626.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$626.90
|
| Rate for Payer: Multiplan Commercial |
$716.46
|
| Rate for Payer: Networks By Design Commercial |
$447.79
|
| Rate for Payer: Prime Health Services Commercial |
$761.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.11
|
| Rate for Payer: United Healthcare All Other HMO |
$327.15
|
| Rate for Payer: United Healthcare HMO Rider |
$320.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$761.23
|
| Rate for Payer: Vantage Medical Group Senior |
$761.23
|
|
|
CATH HDA TRAY 12.5FRX20CM
|
Facility
|
IP
|
$895.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$179.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$403.01
|
| Rate for Payer: Cash Price |
$403.01
|
| Rate for Payer: Cigna of CA HMO |
$626.90
|
| Rate for Payer: Cigna of CA PPO |
$626.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.23
|
| Rate for Payer: EPIC Health Plan Senior |
$358.23
|
| Rate for Payer: Galaxy Health WC |
$761.23
|
| Rate for Payer: Global Benefits Group Commercial |
$537.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.94
|
| Rate for Payer: Multiplan Commercial |
$716.46
|
| Rate for Payer: Networks By Design Commercial |
$447.79
|
| Rate for Payer: Prime Health Services Commercial |
$761.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.11
|
| Rate for Payer: United Healthcare All Other HMO |
$327.15
|
| Rate for Payer: United Healthcare HMO Rider |
$320.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.30
|
|
|
CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 16571-071-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 16571-071-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
CEFACLOR 500 MG CAPSULE [9431]
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 61442-172-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
CEFACLOR 500 MG CAPSULE [9431]
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 61442-172-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 0093-3196-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 0093-3196-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJ (100MG/ML IVPB) [1446]
|
Facility
|
OP
|
$13.26
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$11.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$7.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.27
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$11.27
|
|
