|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
IP
|
$11.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: EPIC Health Plan Senior |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.29
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$5.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$8.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Senior |
$3.90
|
| Rate for Payer: EPIC Health Plan Senior |
$4.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$8.29
|
| Rate for Payer: Galaxy Health WC |
$9.44
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$5.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.29
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.29
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 6068718811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 6068718821
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 6068718811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 3334226011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 3334226011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 6068718821
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 0003161412
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 0003161412
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 4280665830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 3172283330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 4280665830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 3172283330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
OP
|
$294.63
|
|
|
Service Code
|
NDC 5024209130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$250.44 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.06
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.24
|
| Rate for Payer: Multiplan Commercial |
$235.70
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.31
|
| Rate for Payer: United Healthcare All Other HMO |
$147.31
|
| Rate for Payer: United Healthcare HMO Rider |
$147.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.44
|
| Rate for Payer: Vantage Medical Group Senior |
$250.44
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 5024209130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$250.44 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Blue Shield of California Commercial |
$149.38
|
| Rate for Payer: Blue Shield of California Commercial |
$226.57
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.71
|
| Rate for Payer: Multiplan Commercial |
$235.70
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
OP
|
$294.63
|
|
|
Service Code
|
NDC 5024209490
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$250.44 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.06
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.24
|
| Rate for Payer: Multiplan Commercial |
$235.70
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.31
|
| Rate for Payer: United Healthcare All Other HMO |
$147.31
|
| Rate for Payer: United Healthcare HMO Rider |
$147.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.44
|
| Rate for Payer: Vantage Medical Group Senior |
$250.44
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 5024209490
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$250.44 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Blue Shield of California Commercial |
$149.38
|
| Rate for Payer: Blue Shield of California Commercial |
$226.57
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.71
|
| Rate for Payer: Multiplan Commercial |
$235.70
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
IP
|
$25,719.24
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,143.85 |
| Max. Negotiated Rate |
$21,861.35 |
| Rate for Payer: Adventist Health Commercial |
$5,143.85
|
| Rate for Payer: Blue Shield of California Commercial |
$13,039.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19,778.10
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cigna of CA HMO |
$18,003.47
|
| Rate for Payer: Cigna of CA PPO |
$18,003.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,003.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,287.70
|
| Rate for Payer: EPIC Health Plan Senior |
$10,287.70
|
| Rate for Payer: Galaxy Health WC |
$21,861.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,431.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,174.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,172.62
|
| Rate for Payer: Multiplan Commercial |
$20,575.39
|
| Rate for Payer: Networks By Design Commercial |
$12,859.62
|
| Rate for Payer: Prime Health Services Commercial |
$21,861.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,652.43
|
| Rate for Payer: United Healthcare All Other HMO |
$9,395.24
|
| Rate for Payer: United Healthcare HMO Rider |
$9,192.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,423.05
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
OP
|
$25,719.24
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.99 |
| Max. Negotiated Rate |
$21,861.35 |
| Rate for Payer: Adventist Health Commercial |
$5,143.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.66
|
| Rate for Payer: Blue Shield of California Commercial |
$63.36
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cigna of CA HMO |
$18,003.47
|
| Rate for Payer: Cigna of CA PPO |
$18,003.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,003.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.68
|
| Rate for Payer: EPIC Health Plan Senior |
$63.79
|
| Rate for Payer: Galaxy Health WC |
$21,861.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,431.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,172.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.71
|
| Rate for Payer: Multiplan Commercial |
$20,575.39
|
| Rate for Payer: Networks By Design Commercial |
$12,859.62
|
| Rate for Payer: Prime Health Services Commercial |
$21,861.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,431.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,431.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,652.43
|
| Rate for Payer: United Healthcare All Other HMO |
$9,395.24
|
| Rate for Payer: United Healthcare HMO Rider |
$9,192.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,423.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$57.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Vantage Medical Group Senior |
$63.79
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION [238113]
|
Facility
|
IP
|
$2,143.28
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$428.66 |
| Max. Negotiated Rate |
$1,821.79 |
| Rate for Payer: Adventist Health Commercial |
$428.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,648.18
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cigna of CA HMO |
$1,500.30
|
| Rate for Payer: Cigna of CA PPO |
$1,500.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,500.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.31
|
| Rate for Payer: EPIC Health Plan Senior |
$857.31
|
| Rate for Payer: Galaxy Health WC |
$1,821.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,360.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,264.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.39
|
| Rate for Payer: Multiplan Commercial |
$1,714.62
|
| Rate for Payer: Networks By Design Commercial |
$1,071.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.37
|
| Rate for Payer: United Healthcare All Other HMO |
$782.94
|
| Rate for Payer: United Healthcare HMO Rider |
$766.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.92
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION [238113]
|
Facility
|
OP
|
$2,143.28
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.99 |
| Max. Negotiated Rate |
$1,821.79 |
| Rate for Payer: Adventist Health Commercial |
$428.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.66
|
| Rate for Payer: Blue Shield of California Commercial |
$63.36
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cigna of CA HMO |
$1,500.30
|
| Rate for Payer: Cigna of CA PPO |
$1,500.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,500.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.68
|
| Rate for Payer: EPIC Health Plan Senior |
$63.79
|
| Rate for Payer: Galaxy Health WC |
$1,821.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,360.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.71
|
| Rate for Payer: Multiplan Commercial |
$1,714.62
|
| Rate for Payer: Networks By Design Commercial |
$1,071.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.37
|
| Rate for Payer: United Healthcare All Other HMO |
$782.94
|
| Rate for Payer: United Healthcare HMO Rider |
$766.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$57.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Vantage Medical Group Senior |
$63.79
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
|
