|
ESCITALOPRAM 5 MG TABLET [37635]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 60687-865-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
ESCITALOPRAM 5 MG TABLET [37635]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 60687-865-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
ESCITALOPRAM 5 MG TABLET [37635]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 68001-591-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
ESLICARBAZEPINE 200 MG TABLET [204958]
|
Facility
|
OP
|
$53.88
|
|
|
Service Code
|
NDC 63402-202-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.09
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.72
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.94
|
| Rate for Payer: United Healthcare All Other HMO |
$26.94
|
| Rate for Payer: United Healthcare HMO Rider |
$26.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.80
|
| Rate for Payer: Vantage Medical Group Senior |
$45.80
|
|
|
ESLICARBAZEPINE 200 MG TABLET [204958]
|
Facility
|
IP
|
$53.88
|
|
|
Service Code
|
NDC 63402-202-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$39.76
|
| Rate for Payer: Blue Shield of California EPN |
$26.19
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
|
|
ESLICARBAZEPINE 400 MG TABLET [204960]
|
Facility
|
OP
|
$53.88
|
|
|
Service Code
|
NDC 63402-204-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.09
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.72
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.94
|
| Rate for Payer: United Healthcare All Other HMO |
$26.94
|
| Rate for Payer: United Healthcare HMO Rider |
$26.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.80
|
| Rate for Payer: Vantage Medical Group Senior |
$45.80
|
|
|
ESLICARBAZEPINE 400 MG TABLET [204960]
|
Facility
|
IP
|
$53.88
|
|
|
Service Code
|
NDC 63402-204-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$39.76
|
| Rate for Payer: Blue Shield of California EPN |
$26.19
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
|
|
ESLICARBAZEPINE 600 MG TABLET [204961]
|
Facility
|
OP
|
$53.88
|
|
|
Service Code
|
NDC 63402-206-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.09
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.72
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.94
|
| Rate for Payer: United Healthcare All Other HMO |
$26.94
|
| Rate for Payer: United Healthcare HMO Rider |
$26.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.80
|
| Rate for Payer: Vantage Medical Group Senior |
$45.80
|
|
|
ESLICARBAZEPINE 600 MG TABLET [204961]
|
Facility
|
IP
|
$53.88
|
|
|
Service Code
|
NDC 63402-206-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$39.76
|
| Rate for Payer: Blue Shield of California EPN |
$26.19
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
|
|
ESLICARBAZEPINE 800 MG TABLET [204959]
|
Facility
|
IP
|
$29.10
|
|
|
Service Code
|
NDC 68180-293-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Adventist Health Commercial |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$21.48
|
| Rate for Payer: Blue Shield of California EPN |
$14.14
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$20.37
|
| Rate for Payer: Cigna of CA PPO |
$20.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.64
|
| Rate for Payer: Galaxy Health WC |
$24.73
|
| Rate for Payer: Global Benefits Group Commercial |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.98
|
| Rate for Payer: Multiplan Commercial |
$23.28
|
| Rate for Payer: Networks By Design Commercial |
$18.91
|
| Rate for Payer: Prime Health Services Commercial |
$24.73
|
|
|
ESLICARBAZEPINE 800 MG TABLET [204959]
|
Facility
|
OP
|
$29.10
|
|
|
Service Code
|
NDC 68180-293-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Multiplan Commercial |
$23.28
|
| Rate for Payer: Networks By Design Commercial |
$18.91
|
| Rate for Payer: Adventist Health Commercial |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.87
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$20.37
|
| Rate for Payer: Cigna of CA PPO |
$20.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.64
|
| Rate for Payer: Galaxy Health WC |
$24.73
|
| Rate for Payer: Global Benefits Group Commercial |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.37
|
| Rate for Payer: Prime Health Services Commercial |
$24.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.55
|
| Rate for Payer: United Healthcare All Other HMO |
$14.55
|
| Rate for Payer: United Healthcare HMO Rider |
$14.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.73
|
| Rate for Payer: Vantage Medical Group Senior |
$24.73
|
|
|
ESLICARBAZEPINE 800 MG TABLET [204959]
|
Facility
|
IP
|
$53.88
|
|
|
Service Code
|
NDC 63402-208-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$39.76
|
| Rate for Payer: Blue Shield of California EPN |
$26.19
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
|
|
ESLICARBAZEPINE 800 MG TABLET [204959]
|
Facility
|
OP
|
$53.88
|
|
|
Service Code
|
NDC 63402-208-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$45.80 |
| Rate for Payer: Adventist Health Commercial |
$10.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.09
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$37.72
|
| Rate for Payer: Cigna of CA PPO |
$37.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.55
|
| Rate for Payer: EPIC Health Plan Senior |
$21.55
|
| Rate for Payer: Galaxy Health WC |
$45.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.72
|
| Rate for Payer: Multiplan Commercial |
$43.10
|
| Rate for Payer: Networks By Design Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Commercial |
$45.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.94
|
| Rate for Payer: United Healthcare All Other HMO |
$26.94
|
| Rate for Payer: United Healthcare HMO Rider |
$26.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.80
|
| Rate for Payer: Vantage Medical Group Senior |
$45.80
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: EPIC Health Plan Senior |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$5.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.32
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]
|
Facility
|
IP
|
$1.55
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]
|
Facility
|
OP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5020-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.36
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]
|
Facility
|
IP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5020-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]
|
Facility
|
OP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5040-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.36
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]
|
Facility
|
IP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5040-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
|
