|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
OP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$643.42 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.54
|
| Rate for Payer: Blue Shield of California Commercial |
$65.50
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cigna of CA HMO |
$529.87
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$643.42
|
| Rate for Payer: Global Benefits Group Commercial |
$454.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$605.57
|
| Rate for Payer: Networks By Design Commercial |
$378.48
|
| Rate for Payer: Prime Health Services Commercial |
$643.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$454.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.09
|
| Rate for Payer: United Healthcare All Other HMO |
$276.52
|
| Rate for Payer: United Healthcare HMO Rider |
$270.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
|
IP
|
$756.96
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.39 |
| Max. Negotiated Rate |
$643.42 |
| Rate for Payer: Adventist Health Commercial |
$151.39
|
| Rate for Payer: Blue Shield of California Commercial |
$383.78
|
| Rate for Payer: Blue Shield of California Commercial |
$582.10
|
| Rate for Payer: Cash Price |
$340.63
|
| Rate for Payer: Cigna of CA HMO |
$529.87
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.78
|
| Rate for Payer: EPIC Health Plan Senior |
$302.78
|
| Rate for Payer: Galaxy Health WC |
$643.42
|
| Rate for Payer: Global Benefits Group Commercial |
$454.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.67
|
| Rate for Payer: Multiplan Commercial |
$605.57
|
| Rate for Payer: Networks By Design Commercial |
$378.48
|
| Rate for Payer: Prime Health Services Commercial |
$643.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.09
|
| Rate for Payer: United Healthcare All Other HMO |
$276.52
|
| Rate for Payer: United Healthcare HMO Rider |
$270.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.90
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
OP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$1,930.25 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.54
|
| Rate for Payer: Blue Shield of California Commercial |
$65.50
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cigna of CA HMO |
$1,589.62
|
| Rate for Payer: Cigna of CA PPO |
$1,589.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$1,930.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,442.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$1,816.70
|
| Rate for Payer: Networks By Design Commercial |
$1,135.44
|
| Rate for Payer: Prime Health Services Commercial |
$1,930.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$852.26
|
| Rate for Payer: United Healthcare All Other HMO |
$829.55
|
| Rate for Payer: United Healthcare HMO Rider |
$811.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
|
IP
|
$2,270.88
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$454.18 |
| Max. Negotiated Rate |
$1,930.25 |
| Rate for Payer: Adventist Health Commercial |
$454.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,151.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.31
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cigna of CA HMO |
$1,589.62
|
| Rate for Payer: Cigna of CA PPO |
$1,589.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.35
|
| Rate for Payer: EPIC Health Plan Senior |
$908.35
|
| Rate for Payer: Galaxy Health WC |
$1,930.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,442.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.01
|
| Rate for Payer: Multiplan Commercial |
$1,816.70
|
| Rate for Payer: Networks By Design Commercial |
$1,135.44
|
| Rate for Payer: Prime Health Services Commercial |
$1,930.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$852.26
|
| Rate for Payer: United Healthcare All Other HMO |
$829.55
|
| Rate for Payer: United Healthcare HMO Rider |
$811.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.71
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
OP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$3,860.49 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.54
|
| Rate for Payer: Blue Shield of California Commercial |
$65.50
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cigna of CA HMO |
$3,179.22
|
| Rate for Payer: Cigna of CA PPO |
$3,179.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,179.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.48
|
| Rate for Payer: EPIC Health Plan Senior |
$66.32
|
| Rate for Payer: Galaxy Health WC |
$3,860.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,884.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.79
|
| Rate for Payer: Multiplan Commercial |
$3,633.40
|
| Rate for Payer: Networks By Design Commercial |
$2,270.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,860.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,725.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,725.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,704.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,487.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.32
|
| Rate for Payer: Vantage Medical Group Senior |
$66.32
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
|
IP
|
$4,541.75
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$908.35 |
| Max. Negotiated Rate |
$3,860.49 |
| Rate for Payer: Adventist Health Commercial |
$908.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2,302.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,492.61
|
| Rate for Payer: Cash Price |
$2,043.79
|
| Rate for Payer: Cigna of CA HMO |
$3,179.22
|
| Rate for Payer: Cigna of CA PPO |
$3,179.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,179.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,816.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1,816.70
|
| Rate for Payer: Galaxy Health WC |
$3,860.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,884.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,679.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.02
|
| Rate for Payer: Multiplan Commercial |
$3,633.40
|
| Rate for Payer: Networks By Design Commercial |
$2,270.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,860.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,704.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,487.42
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 5022810901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6958411110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Blue Shield of California Commercial |
$323.90
|
| Rate for Payer: Blue Shield of California Commercial |
$328.54
|
| Rate for Payer: Blue Shield of California Commercial |
$498.31
|
| Rate for Payer: Blue Shield of California Commercial |
$213.55
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO |
$453.60
|
| Rate for Payer: Cigna of CA HMO |
$294.84
|
| Rate for Payer: Cigna of CA PPO |
$294.84
|
| Rate for Payer: Cigna of CA PPO |
$453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$294.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$168.48
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$358.02
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Global Benefits Group Commercial |
$252.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Prime Health Services Commercial |
$358.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.19
|
| Rate for Payer: United Healthcare All Other HMO |
$236.71
|
| Rate for Payer: United Healthcare All Other HMO |
$153.86
|
| Rate for Payer: United Healthcare HMO Rider |
$150.54
|
| Rate for Payer: United Healthcare HMO Rider |
$231.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.22
|
|
|
CARMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION [28911]
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$84.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.32
|
| Rate for Payer: Blue Shield of California Commercial |
$900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$900.00
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO |
$453.60
|
| Rate for Payer: Cigna of CA HMO |
$294.84
|
| Rate for Payer: Cigna of CA PPO |
$453.60
|
| Rate for Payer: Cigna of CA PPO |
$294.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$294.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.02
|
| Rate for Payer: EPIC Health Plan Senior |
$264.01
|
| Rate for Payer: EPIC Health Plan Senior |
$264.01
|
| Rate for Payer: Galaxy Health WC |
$358.02
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$252.72
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$393.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$393.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$240.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.61
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$358.02
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.08
|
| Rate for Payer: United Healthcare All Other HMO |
$153.86
|
| Rate for Payer: United Healthcare All Other HMO |
$236.71
|
| Rate for Payer: United Healthcare HMO Rider |
$150.54
|
| Rate for Payer: United Healthcare HMO Rider |
$231.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$240.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$240.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
| Rate for Payer: Vantage Medical Group Senior |
$264.01
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$121,668.62
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$121,668.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,470.40
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$121,668.62
|
| Rate for Payer: EPIC Health Plan Senior |
$81,112.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,738.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103,233.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,809.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$147,934.50
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$147,934.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117,344.14
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$147,934.50
|
| Rate for Payer: EPIC Health Plan Senior |
$98,623.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$89,657.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125,520.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120,140.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$113,724.27
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$113,724.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,897.92
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,724.27
|
| Rate for Payer: EPIC Health Plan Senior |
$75,816.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,923.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,493.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,357.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0093729501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 5107993120
|
| 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 |
$0.10
|
| 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 |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| 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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6586214401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0904630261
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6800115100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0904630261
|
| 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 |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6586214401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6838209401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6800115100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 5107993101
|
| 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: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
