|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
NDC 6195814011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cigna of CA HMO |
$8.81
|
| Rate for Payer: Cigna of CA PPO |
$8.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$10.07
|
| Rate for Payer: Networks By Design Commercial |
$8.18
|
| Rate for Payer: Prime Health Services Commercial |
$10.70
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
NDC 6195814011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cigna of CA HMO |
$8.81
|
| Rate for Payer: Cigna of CA PPO |
$8.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$10.07
|
| Rate for Payer: Networks By Design Commercial |
$8.18
|
| Rate for Payer: Prime Health Services Commercial |
$10.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10.70
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Adventist Health Commercial |
$21.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.46
|
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$75.39
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$75.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Senior |
$29.40
|
| Rate for Payer: EPIC Health Plan Senior |
$43.08
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Galaxy Health WC |
$91.55
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Global Benefits Group Commercial |
$64.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$86.16
|
| Rate for Payer: Networks By Design Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$53.85
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Prime Health Services Commercial |
$91.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.58
|
| Rate for Payer: United Healthcare All Other HMO |
$39.34
|
| Rate for Payer: United Healthcare All Other HMO |
$26.85
|
| Rate for Payer: United Healthcare HMO Rider |
$38.49
|
| Rate for Payer: United Healthcare HMO Rider |
$26.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$91.55
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Adventist Health Commercial |
$21.54
|
| Rate for Payer: Blue Shield of California Commercial |
$82.82
|
| Rate for Payer: Blue Shield of California Commercial |
$37.26
|
| Rate for Payer: Blue Shield of California Commercial |
$56.52
|
| Rate for Payer: Blue Shield of California Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA HMO |
$75.39
|
| Rate for Payer: Cigna of CA PPO |
$75.39
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Senior |
$43.08
|
| Rate for Payer: EPIC Health Plan Senior |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$91.55
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Global Benefits Group Commercial |
$64.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$86.16
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$53.85
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Prime Health Services Commercial |
$91.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.58
|
| Rate for Payer: United Healthcare All Other HMO |
$26.85
|
| Rate for Payer: United Healthcare All Other HMO |
$39.34
|
| Rate for Payer: United Healthcare HMO Rider |
$38.49
|
| Rate for Payer: United Healthcare HMO Rider |
$26.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.07
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,323.77
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$9,044.12 |
| Max. Negotiated Rate |
$11,323.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,044.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,323.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,131.80
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$28,674.00
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$22,901.47 |
| Max. Negotiated Rate |
$28,674.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,901.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,674.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,655.69
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,224.81
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$4,172.97 |
| Max. Negotiated Rate |
$5,224.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,172.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,224.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,674.83
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,614.60
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$5,282.98 |
| Max. Negotiated Rate |
$6,614.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,282.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,614.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,918.33
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 0121177505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0121077516
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 0121177505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.76
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 9999325216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0121077516
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 9999325216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CODEINE SULFATE 15 MG TABLET [1801]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 0054024324
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
CODEINE SULFATE 15 MG TABLET [1801]
|
Facility
|
IP
|
$0.86
|
|
|
Service Code
|
NDC 0054024324
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
|
|
CODEINE SULFATE 30 MG TABLET [1802]
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 0054024424
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
CODEINE SULFATE 30 MG TABLET [1802]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 0054024424
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
CODEINE SULFATE 30 MG TABLET [1802]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 0527169801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
