|
COPPER GLUCONATE 2 MG TABLET [112194]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
COPPER GLUCONATE 2 MG TABLET [112194]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0536143901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 9994-0804-26
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
COPPER SULFATE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080426]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 9994-0804-26
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
OP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$217.86 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.86
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Blue Shield of California EPN |
$96.24
|
| Rate for Payer: Cash Price |
$52.93
|
| Rate for Payer: Cash Price |
$52.93
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.37
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
|
IP
|
$96.24
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$76.99
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.16
|
| Rate for Payer: United Healthcare HMO Rider |
$34.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.52
|
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California Commercial |
$71.03
|
| Rate for Payer: Blue Shield of California EPN |
$46.77
|
| Rate for Payer: Cash Price |
$52.93
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.50
|
| Rate for Payer: EPIC Health Plan Senior |
$38.50
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California Commercial |
$217.23
|
| Rate for Payer: Blue Shield of California EPN |
$143.05
|
| Rate for Payer: Cash Price |
$161.89
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.74
|
| Rate for Payer: EPIC Health Plan Senior |
$117.74
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.64
|
| Rate for Payer: Multiplan Commercial |
$235.48
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$333.17 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.17
|
| Rate for Payer: Blue Shield of California Commercial |
$147.18
|
| Rate for Payer: Blue Shield of California EPN |
$147.18
|
| Rate for Payer: Cash Price |
$161.89
|
| Rate for Payer: Cash Price |
$161.89
|
| Rate for Payer: Cigna of CA HMO |
$206.04
|
| Rate for Payer: Cigna of CA PPO |
$206.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.93
|
| Rate for Payer: EPIC Health Plan Senior |
$129.58
|
| Rate for Payer: Galaxy Health WC |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$176.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$212.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.64
|
| Rate for Payer: Multiplan Commercial |
$235.48
|
| Rate for Payer: Networks By Design Commercial |
$147.18
|
| Rate for Payer: Prime Health Services Commercial |
$250.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.47
|
| Rate for Payer: United Healthcare All Other HMO |
$107.53
|
| Rate for Payer: United Healthcare HMO Rider |
$105.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$129.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.54
|
| Rate for Payer: Vantage Medical Group Senior |
$142.54
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
OP
|
$475.46
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$311.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.98
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$332.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$332.82
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.73
|
| Rate for Payer: United Healthcare All Other HMO |
$237.73
|
| Rate for Payer: United Healthcare HMO Rider |
$237.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Vantage Medical Group Senior |
$404.14
|
|
|
CRIZOTINIB 250 MG CAPSULE [153216]
|
Facility
|
IP
|
$475.46
|
|
|
Service Code
|
NDC 0069-8140-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$404.14 |
| Rate for Payer: Adventist Health Commercial |
$95.09
|
| Rate for Payer: Blue Shield of California Commercial |
$350.89
|
| Rate for Payer: Blue Shield of California EPN |
$231.07
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna of CA HMO |
$332.82
|
| Rate for Payer: Cigna of CA PPO |
$332.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.18
|
| Rate for Payer: EPIC Health Plan Senior |
$190.18
|
| Rate for Payer: Galaxy Health WC |
$404.14
|
| Rate for Payer: Global Benefits Group Commercial |
$285.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.11
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: Networks By Design Commercial |
$309.05
|
| Rate for Payer: Prime Health Services Commercial |
$404.14
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
CROMOLYN 4 % EYE DROPS [9691]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 0409-4092-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$2.44
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.66
|
| Rate for Payer: Cigna of CA PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 9994-0804-25
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$2.44
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [110358]
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 0409-4092-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 10122-313-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
CVL-NICARDIPINE 20 MG/200 ML PREMIX FOR INTRA-ART/INTRA-CORONARY [4081031]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 10122-313-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
CVL-NITROGLYCERIN 50MG/500ML NS FOR IA/IC BOLUS [4080932]
|
Facility
|
OP
|
$8.75
|
|
|
Service Code
|
NDC 9994-0809-32
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.37
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$6.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.44
|
| Rate for Payer: Global Benefits Group Commercial |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$5.69
|
| Rate for Payer: Prime Health Services Commercial |
$7.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.44
|
| Rate for Payer: Vantage Medical Group Senior |
$7.44
|
|
|
CVL-NITROGLYCERIN 50MG/500ML NS FOR IA/IC BOLUS [4080932]
|
Facility
|
IP
|
$8.75
|
|
|
Service Code
|
NDC 9994-0809-32
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: EPIC Health Plan Senior |
$3.50
|
| Rate for Payer: Galaxy Health WC |
$7.44
|
| Rate for Payer: Global Benefits Group Commercial |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$5.69
|
| Rate for Payer: Prime Health Services Commercial |
$7.44
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 9994-0809-34
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| 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 |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
CVL-VERAPAMIL 5MG/50ML NS FOR IA/IC BOLUS [4080934]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
NDC 9994-0809-34
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| 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 |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$1.85
|
| Rate for Payer: Cigna of CA PPO |
$1.85
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.06
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$1.32
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
|
