|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0254-2008-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.73
|
| Rate for Payer: Global Benefits Group Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Networks By Design Commercial |
$4.38
|
| Rate for Payer: Prime Health Services Commercial |
$5.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Other HMO |
$3.37
|
| Rate for Payer: United Healthcare HMO Rider |
$3.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: Vantage Medical Group Senior |
$5.73
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 65162-710-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 50268-187-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.12
|
| Rate for Payer: Cigna of CA PPO |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Senior |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$3.79
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$8.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.42
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cigna of CA HMO |
$7.80
|
| Rate for Payer: Cigna of CA PPO |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Senior |
$4.46
|
| Rate for Payer: Galaxy Health WC |
$9.48
|
| Rate for Payer: Global Benefits Group Commercial |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
| Rate for Payer: Networks By Design Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$9.48
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.07
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.07
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.32
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.79
|
| Rate for Payer: Blue Shield of California EPN |
$16.32
|
| Rate for Payer: Blue Shield of California EPN |
$16.33
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.79
|
| Rate for Payer: Blue Shield of California EPN |
$16.32
|
| Rate for Payer: Blue Shield of California EPN |
$16.33
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG MED NEB SOLUTION [4080399]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.79
|
| Rate for Payer: Blue Shield of California EPN |
$16.32
|
| Rate for Payer: Blue Shield of California EPN |
$16.33
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
|
|
COLISTIN (COLISTIMETHATE) 37.5 MG CBA/ML SWFI INJ DILUTION [4082134]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Blue Shield of California EPN |
$33.11
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$23.51
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$23.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$28.55
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$20.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.51
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.55
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$12.70
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$10.79 |
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$12.07
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.41
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Senior |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.45
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO |
$6.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.26
|
| Rate for Payer: Vantage Medical Group Senior |
$10.26
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$12.70
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$10.79 |
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.80
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.79
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6.35
|
| Rate for Payer: United Healthcare HMO Rider |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$10.79
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$10.45
|
|
|
Service Code
|
NDC 9999-9996-82
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7.71
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.88
|
| Rate for Payer: Global Benefits Group Commercial |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.88
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
IP
|
$12.07
|
|
|
Service Code
|
NDC 50484-010-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$8.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.87
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Senior |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$10.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$7.85
|
| Rate for Payer: Prime Health Services Commercial |
$10.26
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [9682]
|
Facility
|
OP
|
$10.45
|
|
|
Service Code
|
NDC 9999-9996-82
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.42
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.88
|
| Rate for Payer: Global Benefits Group Commercial |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.88
|
|
|
COLLOIDAL OATMEAL TOPICAL PACKET [81870]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 8137003640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
COLLOIDAL OATMEAL TOPICAL PACKET [81870]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 8137003640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
COMPOUNDING VEHICLE (FLAVOR SWEET) NO 8 ORAL LIQUID [37965]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0574030416
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
