|
DOXORUBICIN BEADS (100-300 LC BEADS) [4081299]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
CPT J9000
|
| Hospital Charge Code |
1755775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
DOXORUBICIN BEADS (100-300 LC BEADS) [4081299]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
CPT J9000
|
| Hospital Charge Code |
1755775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$105.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.96
|
| Rate for Payer: Blue Distinction Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Media |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
DOXORUBICIN BEADS (QUADRASPHERE) [4081287]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
CPT J9000
|
| Hospital Charge Code |
1755775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
DOXORUBICIN BEADS (QUADRASPHERE) [4081287]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
CPT J9000
|
| Hospital Charge Code |
1755775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$105.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.96
|
| Rate for Payer: Blue Distinction Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Media |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
OP
|
$81.40
|
|
|
Service Code
|
NDC 70710-1530-1
|
| Hospital Charge Code |
1755636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.54 |
| Max. Negotiated Rate |
$69.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.50
|
| Rate for Payer: Blue Distinction Transplant |
$48.84
|
| Rate for Payer: Blue Shield of California Commercial |
$59.99
|
| Rate for Payer: Blue Shield of California EPN |
$47.54
|
| Rate for Payer: Cash Price |
$36.63
|
| Rate for Payer: Cigna of CA HMO |
$56.98
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.19
|
| Rate for Payer: Dignity Health Media |
$69.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.56
|
| Rate for Payer: Galaxy Health WC |
$69.19
|
| Rate for Payer: Global Benefits Group Commercial |
$48.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$65.12
|
| Rate for Payer: Networks By Design Commercial |
$40.70
|
| Rate for Payer: Prime Health Services Commercial |
$69.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.70
|
| Rate for Payer: United Healthcare All Other HMO |
$40.70
|
| Rate for Payer: United Healthcare HMO Rider |
$40.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.19
|
| Rate for Payer: Vantage Medical Group Senior |
$69.19
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
NDC 0338-0067-01
|
| Hospital Charge Code |
1755794
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Distinction Transplant |
$48.50
|
| Rate for Payer: Blue Shield of California Commercial |
$59.57
|
| Rate for Payer: Blue Shield of California EPN |
$47.20
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Media |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Networks By Design Commercial |
$40.42
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
IP
|
$81.40
|
|
|
Service Code
|
NDC 70710-1530-1
|
| Hospital Charge Code |
1755636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.54 |
| Max. Negotiated Rate |
$69.19 |
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California EPN |
$41.68
|
| Rate for Payer: Cash Price |
$36.63
|
| Rate for Payer: Cigna of CA HMO |
$56.98
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.56
|
| Rate for Payer: Galaxy Health WC |
$69.19
|
| Rate for Payer: Global Benefits Group Commercial |
$48.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$65.12
|
| Rate for Payer: Networks By Design Commercial |
$40.70
|
| Rate for Payer: Prime Health Services Commercial |
$69.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.74
|
| Rate for Payer: United Healthcare All Other HMO |
$30.02
|
| Rate for Payer: United Healthcare HMO Rider |
$29.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
IP
|
$80.83
|
|
|
Service Code
|
NDC 0338-0067-01
|
| Hospital Charge Code |
1755794
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Blue Shield of California Commercial |
$57.55
|
| Rate for Payer: Blue Shield of California EPN |
$41.38
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO |
$56.58
|
| Rate for Payer: Cigna of CA PPO |
$56.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Networks By Design Commercial |
$40.42
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.52
|
| Rate for Payer: United Healthcare All Other HMO |
$29.81
|
| Rate for Payer: United Healthcare HMO Rider |
$29.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.67
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 43598-541-25
|
| Hospital Charge Code |
1755794
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.75
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$44.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.04
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Media |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 43598-541-25
|
| Hospital Charge Code |
1755794
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Blue Shield of California Commercial |
$42.72
|
| Rate for Payer: Blue Shield of California EPN |
$30.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.66
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
NDC 43598-283-35
|
| Hospital Charge Code |
1755636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Blue Shield of California Commercial |
$38.45
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.39
|
| Rate for Payer: United Healthcare All Other HMO |
$19.92
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.82
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
NDC 43598-283-35
|
| Hospital Charge Code |
1755636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.17
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.80
|
| Rate for Payer: Blue Shield of California EPN |
$31.54
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Media |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
DOXYCYCLINE 10 MG/ML TOPICAL [4081094]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 99994-0810-94
|
| Hospital Charge Code |
NDC4081094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Distinction Transplant |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Media |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
DOXYCYCLINE 10 MG/ML TOPICAL [4081094]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 99994-0810-94
|
| Hospital Charge Code |
NDC4081094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 50268-278-11
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
NDC 50268-278-15
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
NDC 60687-513-65
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| 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: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| 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
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0143-9803-50
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| 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: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| 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
|
$1.44
|
|
|
Service Code
|
NDC 0143-3142-50
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| 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: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 0069-0950-50
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Distinction Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
NDC 60687-513-65
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| 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 |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Distinction Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| 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 Media |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| 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
|
| 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 CAPSULE [2623]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0143-3142-50
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| 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 |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: Blue Distinction Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| 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 Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
| 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
|
$2.01
|
|
|
Service Code
|
NDC 60687-513-11
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| 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: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| 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 60687-513-11
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| 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 |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Distinction Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| 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 Media |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| 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
|
| 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 CAPSULE [2623]
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
NDC 50268-278-11
|
| Hospital Charge Code |
1711312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Blue Distinction Transplant |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Media |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
