|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 9999481192
|
| 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 |
$23.44
|
| Rate for Payer: Cash Price |
$16.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| 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 3 MG/ML TOPICAL [4081091]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 9999481191
|
| 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 |
$23.44
|
| Rate for Payer: Cash Price |
$16.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| 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 3 MG/ML TOPICAL [4081091]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 9999481191
|
| 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 |
$18.52
|
| Rate for Payer: Blue Shield of California Commercial |
$28.09
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| 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 5 MG/ML TOPICAL [4081159]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 9999481159
|
| 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 |
$23.44
|
| Rate for Payer: Cash Price |
$16.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| 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 5 MG/ML TOPICAL [4081159]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 9999481159
|
| 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 |
$18.52
|
| Rate for Payer: Blue Shield of California Commercial |
$28.09
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| 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 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
|
OP
|
$237.29
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$3,282.05 |
| Rate for Payer: United Healthcare HMO Rider |
$84.81
|
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Adventist Health Commercial |
$35.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,282.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,282.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$589.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$589.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,801.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,801.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.23
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$106.78
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$106.78
|
| Rate for Payer: Cigna of CA HMO |
$166.10
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$166.10
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.97
|
| Rate for Payer: EPIC Health Plan Senior |
$589.31
|
| Rate for Payer: EPIC Health Plan Senior |
$589.31
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Galaxy Health WC |
$201.70
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Global Benefits Group Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$878.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$878.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$535.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$996.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$996.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$750.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$750.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$675.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$675.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$717.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$717.89
|
| Rate for Payer: Multiplan Commercial |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$189.83
|
| Rate for Payer: Networks By Design Commercial |
$118.64
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Prime Health Services Commercial |
$201.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.65
|
| Rate for Payer: United Healthcare All Other HMO |
$64.88
|
| Rate for Payer: United Healthcare All Other HMO |
$86.68
|
| Rate for Payer: United Healthcare HMO Rider |
$63.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$535.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$535.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.31
|
| Rate for Payer: Vantage Medical Group Senior |
$589.31
|
| Rate for Payer: Vantage Medical Group Senior |
$589.31
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
|
IP
|
$237.29
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$201.70 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Adventist Health Commercial |
$35.52
|
| Rate for Payer: Blue Shield of California Commercial |
$90.04
|
| Rate for Payer: Blue Shield of California Commercial |
$120.31
|
| Rate for Payer: Blue Shield of California Commercial |
$182.48
|
| Rate for Payer: Blue Shield of California Commercial |
$136.57
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$106.78
|
| Rate for Payer: Cigna of CA HMO |
$166.10
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$166.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$71.04
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Galaxy Health WC |
$201.70
|
| Rate for Payer: Global Benefits Group Commercial |
$142.37
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.95
|
| Rate for Payer: Multiplan Commercial |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$189.83
|
| Rate for Payer: Networks By Design Commercial |
$118.64
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: Prime Health Services Commercial |
$201.70
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.05
|
| Rate for Payer: United Healthcare All Other HMO |
$86.68
|
| Rate for Payer: United Healthcare All Other HMO |
$64.88
|
| Rate for Payer: United Healthcare HMO Rider |
$63.47
|
| Rate for Payer: United Healthcare HMO Rider |
$84.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.71
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0093206406
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0093206406
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CILOSTAZOL 50 MG TABLET [24473]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 0093206506
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
CILOSTAZOL 50 MG TABLET [24473]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 0093206506
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 1672944010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 6909741002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 1672944010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 6909741002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 6787750330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
OP
|
$26.50
|
|
|
Service Code
|
NDC 6068751611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.01
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cigna of CA HMO |
$18.55
|
| Rate for Payer: Cigna of CA PPO |
$18.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10.60
|
| Rate for Payer: Galaxy Health WC |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$15.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$21.20
|
| Rate for Payer: Networks By Design Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO |
$13.25
|
| Rate for Payer: United Healthcare HMO Rider |
$13.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.52
|
| Rate for Payer: Vantage Medical Group Senior |
$22.52
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 6438088304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 1672944015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 1672944015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$26.50
|
|
|
Service Code
|
NDC 6068751621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.44
|
| Rate for Payer: Blue Shield of California Commercial |
$20.38
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cigna of CA HMO |
$18.55
|
| Rate for Payer: Cigna of CA PPO |
$18.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10.60
|
| Rate for Payer: Galaxy Health WC |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$15.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$21.20
|
| Rate for Payer: Networks By Design Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.52
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 6909741002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 1672944010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
IP
|
$26.50
|
|
|
Service Code
|
NDC 6068751611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.44
|
| Rate for Payer: Blue Shield of California Commercial |
$20.38
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cigna of CA HMO |
$18.55
|
| Rate for Payer: Cigna of CA PPO |
$18.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10.60
|
| Rate for Payer: Galaxy Health WC |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$15.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$21.20
|
| Rate for Payer: Networks By Design Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.52
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 1672944010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
