|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 42806-266-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 42806-266-98
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 42806-266-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 42806-266-98
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
|
OP
|
$416.85
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.37 |
| Max. Negotiated Rate |
$354.32 |
| Rate for Payer: Adventist Health Commercial |
$83.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.99
|
| Rate for Payer: Cash Price |
$229.27
|
| Rate for Payer: Cigna of CA HMO |
$266.78
|
| Rate for Payer: Cigna of CA PPO |
$308.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$354.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.74
|
| Rate for Payer: EPIC Health Plan Senior |
$166.74
|
| Rate for Payer: Galaxy Health WC |
$354.32
|
| Rate for Payer: Global Benefits Group Commercial |
$250.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$333.48
|
| Rate for Payer: Networks By Design Commercial |
$270.95
|
| Rate for Payer: Prime Health Services Commercial |
$354.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.43
|
| Rate for Payer: United Healthcare All Other HMO |
$208.43
|
| Rate for Payer: United Healthcare HMO Rider |
$208.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$354.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.32
|
| Rate for Payer: Vantage Medical Group Senior |
$354.32
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
|
IP
|
$416.85
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.37 |
| Max. Negotiated Rate |
$354.32 |
| Rate for Payer: Adventist Health Commercial |
$83.37
|
| Rate for Payer: Blue Shield of California Commercial |
$307.64
|
| Rate for Payer: Blue Shield of California EPN |
$202.59
|
| Rate for Payer: Cash Price |
$229.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.74
|
| Rate for Payer: EPIC Health Plan Senior |
$166.74
|
| Rate for Payer: Galaxy Health WC |
$354.32
|
| Rate for Payer: Global Benefits Group Commercial |
$250.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.04
|
| Rate for Payer: Multiplan Commercial |
$333.48
|
| Rate for Payer: Networks By Design Commercial |
$270.95
|
| Rate for Payer: Prime Health Services Commercial |
$354.32
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
|
OP
|
$475.85
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.17 |
| Max. Negotiated Rate |
$404.47 |
| Rate for Payer: Adventist Health Commercial |
$95.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.22
|
| Rate for Payer: Cash Price |
$261.72
|
| Rate for Payer: Cigna of CA HMO |
$304.54
|
| Rate for Payer: Cigna of CA PPO |
$352.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.34
|
| Rate for Payer: EPIC Health Plan Senior |
$190.34
|
| Rate for Payer: Galaxy Health WC |
$404.47
|
| Rate for Payer: Global Benefits Group Commercial |
$285.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.10
|
| Rate for Payer: Multiplan Commercial |
$380.68
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$404.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.93
|
| Rate for Payer: United Healthcare All Other HMO |
$237.93
|
| Rate for Payer: United Healthcare HMO Rider |
$237.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.47
|
| Rate for Payer: Vantage Medical Group Senior |
$404.47
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
|
IP
|
$475.85
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.17 |
| Max. Negotiated Rate |
$404.47 |
| Rate for Payer: Adventist Health Commercial |
$95.17
|
| Rate for Payer: Cash Price |
$261.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.34
|
| Rate for Payer: EPIC Health Plan Senior |
$190.34
|
| Rate for Payer: Galaxy Health WC |
$404.47
|
| Rate for Payer: Global Benefits Group Commercial |
$285.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.20
|
| Rate for Payer: Multiplan Commercial |
$380.68
|
| Rate for Payer: Networks By Design Commercial |
$309.30
|
| Rate for Payer: Prime Health Services Commercial |
$404.47
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.46
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE [227971]
|
Facility
|
OP
|
$389.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$330.89 |
| Rate for Payer: Adventist Health Commercial |
$77.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$330.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.06
|
| Rate for Payer: Cash Price |
$214.10
|
| Rate for Payer: Cigna of CA HMO |
$272.50
|
| Rate for Payer: Cigna of CA PPO |
$272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$330.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.71
|
| Rate for Payer: EPIC Health Plan Senior |
$155.71
|
| Rate for Payer: Galaxy Health WC |
$330.89
|
| Rate for Payer: Global Benefits Group Commercial |
$233.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$272.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$311.42
|
| Rate for Payer: Networks By Design Commercial |
$194.64
|
| Rate for Payer: Prime Health Services Commercial |
$330.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$233.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$233.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.10
|
| Rate for Payer: United Healthcare All Other HMO |
$142.20
|
| Rate for Payer: United Healthcare HMO Rider |
$139.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$330.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.89
|
| Rate for Payer: Vantage Medical Group Senior |
$330.89
|
|
|
C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE [227971]
|
Facility
|
IP
|
$389.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$330.89 |
| Rate for Payer: Cigna of CA PPO |
$272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.71
|
| Rate for Payer: EPIC Health Plan Senior |
$155.71
|
| Rate for Payer: Galaxy Health WC |
$330.89
|
| Rate for Payer: Global Benefits Group Commercial |
$233.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.43
|
| Rate for Payer: Multiplan Commercial |
$311.42
|
| Rate for Payer: Networks By Design Commercial |
$194.64
|
| Rate for Payer: Prime Health Services Commercial |
$330.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.10
|
| Rate for Payer: United Healthcare All Other HMO |
$142.20
|
| Rate for Payer: United Healthcare HMO Rider |
$139.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.49
|
| Rate for Payer: Cigna of CA HMO |
$272.50
|
| Rate for Payer: Adventist Health Commercial |
$77.86
|
| Rate for Payer: Blue Shield of California Commercial |
$287.29
|
| Rate for Payer: Blue Shield of California EPN |
$189.19
|
| Rate for Payer: Cash Price |
$214.10
|
|
|
CICLOPIROX 0.77 % TOPICAL CREAM [9598]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 45802-138-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CICLOPIROX 0.77 % TOPICAL CREAM [9598]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 45802-138-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 45802-141-67
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO |
$2.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Vantage Medical Group Senior |
$3.71
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
NDC 21922-053-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.17
|
| Rate for Payer: Cigna of CA PPO |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: EPIC Health Plan Senior |
$1.24
|
| Rate for Payer: Galaxy Health WC |
$2.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.63
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 45802-141-67
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
NDC 21922-053-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.90
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.17
|
| Rate for Payer: Cigna of CA PPO |
$2.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: EPIC Health Plan Senior |
$1.24
|
| Rate for Payer: Galaxy Health WC |
$2.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.63
|
| Rate for Payer: Vantage Medical Group Senior |
$2.63
|
|
|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.03
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other HMO |
$12.24
|
| Rate for Payer: United Healthcare HMO Rider |
$12.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.81
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$18.07
|
| Rate for Payer: Blue Shield of California EPN |
$11.90
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.43
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$26.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.75
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$26.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.75
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.43
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
