|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
IP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$386.99 |
| Rate for Payer: EPIC Health Plan Commercial |
$182.11
|
| Rate for Payer: EPIC Health Plan Senior |
$182.11
|
| Rate for Payer: Galaxy Health WC |
$386.99
|
| Rate for Payer: Cigna of CA HMO |
$318.70
|
| Rate for Payer: Cigna of CA PPO |
$318.70
|
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California Commercial |
$336.00
|
| Rate for Payer: Blue Shield of California EPN |
$221.27
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: Global Benefits Group Commercial |
$273.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.27
|
| Rate for Payer: Multiplan Commercial |
$364.22
|
| Rate for Payer: Networks By Design Commercial |
$295.93
|
| Rate for Payer: Prime Health Services Commercial |
$386.99
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
OP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$386.99 |
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$298.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.59
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: Cigna of CA HMO |
$318.70
|
| Rate for Payer: Cigna of CA PPO |
$318.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.11
|
| Rate for Payer: EPIC Health Plan Senior |
$182.11
|
| Rate for Payer: Galaxy Health WC |
$386.99
|
| Rate for Payer: Global Benefits Group Commercial |
$273.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.70
|
| Rate for Payer: Multiplan Commercial |
$364.22
|
| Rate for Payer: Networks By Design Commercial |
$295.93
|
| Rate for Payer: Prime Health Services Commercial |
$386.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.64
|
| Rate for Payer: United Healthcare All Other HMO |
$227.64
|
| Rate for Payer: United Healthcare HMO Rider |
$227.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.99
|
| Rate for Payer: Vantage Medical Group Senior |
$386.99
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
IP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$515.98 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Blue Shield of California Commercial |
$448.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.02
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: Cigna of CA HMO |
$424.93
|
| Rate for Payer: Cigna of CA PPO |
$424.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.82
|
| Rate for Payer: EPIC Health Plan Senior |
$242.82
|
| Rate for Payer: Galaxy Health WC |
$515.98
|
| Rate for Payer: Global Benefits Group Commercial |
$364.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$404.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.69
|
| Rate for Payer: Multiplan Commercial |
$485.63
|
| Rate for Payer: Networks By Design Commercial |
$394.58
|
| Rate for Payer: Prime Health Services Commercial |
$515.98
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
OP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$515.98 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$398.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.78
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: Cigna of CA HMO |
$424.93
|
| Rate for Payer: Cigna of CA PPO |
$424.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$515.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.82
|
| Rate for Payer: EPIC Health Plan Senior |
$242.82
|
| Rate for Payer: Galaxy Health WC |
$515.98
|
| Rate for Payer: Global Benefits Group Commercial |
$364.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$404.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.93
|
| Rate for Payer: Multiplan Commercial |
$485.63
|
| Rate for Payer: Networks By Design Commercial |
$394.58
|
| Rate for Payer: Prime Health Services Commercial |
$515.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.52
|
| Rate for Payer: United Healthcare All Other HMO |
$303.52
|
| Rate for Payer: United Healthcare HMO Rider |
$303.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.98
|
| Rate for Payer: Vantage Medical Group Senior |
$515.98
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
IP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Blue Shield of California Commercial |
$559.99
|
| Rate for Payer: Blue Shield of California EPN |
$368.78
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: Cigna of CA HMO |
$531.16
|
| Rate for Payer: Cigna of CA PPO |
$531.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.52
|
| Rate for Payer: EPIC Health Plan Senior |
$303.52
|
| Rate for Payer: Galaxy Health WC |
$644.98
|
| Rate for Payer: Global Benefits Group Commercial |
$455.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.11
|
| Rate for Payer: Multiplan Commercial |
$607.04
|
| Rate for Payer: Networks By Design Commercial |
$493.22
|
| Rate for Payer: Prime Health Services Commercial |
$644.98
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
OP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.98
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: Cigna of CA HMO |
$531.16
|
| Rate for Payer: Cigna of CA PPO |
$531.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.52
|
| Rate for Payer: EPIC Health Plan Senior |
$303.52
|
| Rate for Payer: Galaxy Health WC |
$644.98
|
| Rate for Payer: Global Benefits Group Commercial |
$455.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.16
|
| Rate for Payer: Multiplan Commercial |
$607.04
|
| Rate for Payer: Networks By Design Commercial |
$493.22
|
| Rate for Payer: Prime Health Services Commercial |
$644.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.40
|
| Rate for Payer: United Healthcare All Other HMO |
$379.40
|
| Rate for Payer: United Healthcare HMO Rider |
$379.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.98
|
| Rate for Payer: Vantage Medical Group Senior |
$644.98
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
IP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$783.02 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Blue Shield of California Commercial |
$679.85
|
| Rate for Payer: Blue Shield of California EPN |
$447.70
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Cigna of CA HMO |
$644.84
|
| Rate for Payer: Cigna of CA PPO |
$644.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.48
|
| Rate for Payer: EPIC Health Plan Senior |
$368.48
|
| Rate for Payer: Galaxy Health WC |
$783.02
|
| Rate for Payer: Global Benefits Group Commercial |
$552.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.09
|
| Rate for Payer: Multiplan Commercial |
$736.96
|
| Rate for Payer: Networks By Design Commercial |
$460.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.73
|
| Rate for Payer: United Healthcare All Other HMO |
$336.51
|
| Rate for Payer: United Healthcare HMO Rider |
$329.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.69
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
OP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$783.02 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.71
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Cigna of CA HMO |
$644.84
|
| Rate for Payer: Cigna of CA PPO |
$644.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$783.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$783.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$783.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.48
|
| Rate for Payer: EPIC Health Plan Senior |
$368.48
|
| Rate for Payer: Galaxy Health WC |
$783.02
|
| Rate for Payer: Global Benefits Group Commercial |
$552.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.84
|
| Rate for Payer: Multiplan Commercial |
$736.96
|
| Rate for Payer: Networks By Design Commercial |
$460.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.73
|
| Rate for Payer: United Healthcare All Other HMO |
$336.51
|
| Rate for Payer: United Healthcare HMO Rider |
$329.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$783.02
|
| Rate for Payer: Vantage Medical Group Senior |
$783.02
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 42806-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 42806-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: EPIC Health Plan Senior |
$104.58
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$104.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.14
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$104.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.04
|
| Rate for Payer: Vantage Medical Group Senior |
$115.04
|
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.23
|
| Rate for Payer: Blue Shield of California Commercial |
$154.20
|
| Rate for Payer: Blue Shield of California EPN |
$154.20
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.18
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Blue Shield of California Commercial |
$624.35
|
| Rate for Payer: Blue Shield of California EPN |
$411.16
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$592.20
|
| Rate for Payer: Cigna of CA PPO |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$423.00
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.04
|
| Rate for Payer: United Healthcare HMO Rider |
$302.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.06
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California Commercial |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$103.67
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Blue Shield of California EPN |
$75.03
|
| Rate for Payer: Blue Shield of California EPN |
$68.27
|
| Rate for Payer: Blue Shield of California EPN |
$80.95
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.62
|
| Rate for Payer: EPIC Health Plan Senior |
$56.19
|
| Rate for Payer: EPIC Health Plan Senior |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$123.51
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$77.19
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare All Other HMO |
$60.84
|
| Rate for Payer: United Healthcare All Other HMO |
$51.32
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$56.40
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$55.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare HMO Rider |
$59.53
|
| Rate for Payer: United Healthcare HMO Rider |
$50.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
OP
|
$140.48
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.62
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$123.51
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$77.19
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$56.40
|
| Rate for Payer: United Healthcare All Other HMO |
$51.32
|
| Rate for Payer: United Healthcare All Other HMO |
$60.84
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$55.18
|
| Rate for Payer: United Healthcare HMO Rider |
$59.53
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$50.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
| Rate for Payer: Vantage Medical Group Senior |
$141.58
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$103.67
|
| Rate for Payer: Blue Shield of California Commercial |
$35.42
|
| Rate for Payer: Blue Shield of California Commercial |
$88.56
|
| Rate for Payer: Blue Shield of California EPN |
$68.27
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Blue Shield of California EPN |
$23.33
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare All Other HMO |
$51.32
|
| Rate for Payer: United Healthcare HMO Rider |
$50.21
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.01
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.34
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$51.32
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$50.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.28
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.74
|
|
