|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6923811002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0143980350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 0904042806
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.08
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 5026827815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 5026827811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0143980350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 5026827811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0143314250
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0143314250
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
NDC 6068751365
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
NDC 6068751311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1.71
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]
|
Facility
|
IP
|
$28.99
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Multiplan Commercial |
$23.19
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$20.22
|
| Rate for Payer: Multiplan Commercial |
$16.01
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Networks By Design Commercial |
$10.01
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Networks By Design Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$19.43
|
| Rate for Payer: Blue Shield of California Commercial |
$14.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.29
|
| Rate for Payer: Blue Shield of California Commercial |
$24.30
|
| Rate for Payer: Blue Shield of California Commercial |
$16.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.39
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.54
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO |
$12.33
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$14.01
|
| Rate for Payer: Cigna of CA HMO |
$22.12
|
| Rate for Payer: Cigna of CA HMO |
$20.29
|
| Rate for Payer: Cigna of CA HMO |
$17.69
|
| Rate for Payer: Cigna of CA PPO |
$14.01
|
| Rate for Payer: Cigna of CA PPO |
$17.69
|
| Rate for Payer: Cigna of CA PPO |
$12.33
|
| Rate for Payer: Cigna of CA PPO |
$20.29
|
| Rate for Payer: Cigna of CA PPO |
$22.12
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.04
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10.11
|
| Rate for Payer: Galaxy Health WC |
$24.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$17.01
|
| Rate for Payer: Galaxy Health WC |
$21.48
|
| Rate for Payer: Galaxy Health WC |
$14.97
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$17.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Global Benefits Group Commercial |
$10.57
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$14.97
|
| Rate for Payer: Prime Health Services Commercial |
$17.01
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: Prime Health Services Commercial |
$21.48
|
| Rate for Payer: Prime Health Services Commercial |
$24.64
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare All Other HMO |
$11.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]
|
Facility
|
OP
|
$25.27
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$17.69
|
| Rate for Payer: Cigna of CA HMO |
$14.01
|
| Rate for Payer: Cigna of CA HMO |
$22.12
|
| Rate for Payer: Cigna of CA HMO |
$20.29
|
| Rate for Payer: Cigna of CA HMO |
$12.33
|
| Rate for Payer: Cigna of CA PPO |
$22.12
|
| Rate for Payer: Cigna of CA PPO |
$20.29
|
| Rate for Payer: Cigna of CA PPO |
$17.69
|
| Rate for Payer: Cigna of CA PPO |
$12.33
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$17.01
|
| Rate for Payer: Vantage Medical Group Senior |
$14.97
|
| Rate for Payer: Vantage Medical Group Senior |
$21.48
|
| Rate for Payer: Vantage Medical Group Senior |
$24.64
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.11
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$14.97
|
| Rate for Payer: Galaxy Health WC |
$21.48
|
| Rate for Payer: Galaxy Health WC |
$17.01
|
| Rate for Payer: Galaxy Health WC |
$24.64
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$17.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.57
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Global Benefits Group Commercial |
$12.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.29
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$16.01
|
| Rate for Payer: Multiplan Commercial |
$20.22
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$23.19
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Networks By Design Commercial |
$10.01
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Networks By Design Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$15.80
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.48
|
| Rate for Payer: Prime Health Services Commercial |
$14.97
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: Prime Health Services Commercial |
$17.01
|
| Rate for Payer: Prime Health Services Commercial |
$24.64
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.61
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO |
$9.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$11.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.59
|
| Rate for Payer: United Healthcare HMO Rider |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION FOR SCLEROSIS [4082622]
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna of CA HMO |
$22.12
|
| Rate for Payer: Cigna of CA PPO |
$22.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Networks By Design Commercial |
$15.80
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other HMO |
$11.54
|
| Rate for Payer: United Healthcare HMO Rider |
$11.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION FOR SCLEROSIS [4082622]
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.55
|
| Rate for Payer: Blue Shield of California Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$14.56
|
| Rate for Payer: Cigna of CA PPO |
$14.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$17.68
|
| Rate for Payer: Global Benefits Group Commercial |
$12.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.81
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION FOR SCLEROSIS [4082622]
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$14.56
|
| Rate for Payer: Cigna of CA PPO |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$17.68
|
| Rate for Payer: Global Benefits Group Commercial |
$12.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.56
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.81
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$17.68
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION FOR SCLEROSIS [4082622]
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California Commercial |
$16.02
|
| Rate for Payer: Blue Shield of California Commercial |
$24.30
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna of CA HMO |
$22.12
|
| Rate for Payer: Cigna of CA PPO |
$22.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Networks By Design Commercial |
$15.80
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other HMO |
$11.54
|
| Rate for Payer: United Healthcare HMO Rider |
$11.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.35
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 0904043004
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 5026827911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.75
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 0904043004
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.79
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 5026827915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.75
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 0904043006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 4280631250
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 5026827915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET [2625]
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 5026827911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
|
