|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
|
IP
|
$11.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California Commercial |
$13.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Blue Shield of California EPN |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA HMO |
$7.76
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$9.42
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.58
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
IP
|
$11.04
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.18
|
| Rate for Payer: Blue Shield of California Commercial |
$13.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$7.73
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.42
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$7.73
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.42
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.38
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
OP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$25.33 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.37
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$10.65
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.28
|
| Rate for Payer: Blue Shield of California Commercial |
$21.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Blue Shield of California EPN |
$14.48
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Cash Price |
$16.39
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$5.37
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.18
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
OP
|
$11.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$13.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.39
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 33342-260-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 33342-260-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.37
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.32
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$224.48
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.30
|
| Rate for Payer: United Healthcare All Other HMO |
$140.30
|
| Rate for Payer: United Healthcare HMO Rider |
$140.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California Commercial |
$207.08
|
| Rate for Payer: Blue Shield of California EPN |
$136.37
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.34
|
| Rate for Payer: Multiplan Commercial |
$224.48
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California Commercial |
$207.08
|
| Rate for Payer: Blue Shield of California EPN |
$136.37
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.34
|
| Rate for Payer: Multiplan Commercial |
$224.48
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.32
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$224.48
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.30
|
| Rate for Payer: United Healthcare All Other HMO |
$140.30
|
| Rate for Payer: United Healthcare HMO Rider |
$140.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
