|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.55
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$49.31
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$83.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$36.03
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$35.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.83
|
| Rate for Payer: Vantage Medical Group Senior |
$83.83
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$69.03
|
| Rate for Payer: Cigna of CA PPO |
$69.03
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.45
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$83.83
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Global Benefits Group Commercial |
$59.17
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.03
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$78.90
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
IP
|
$98.62
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$83.83 |
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California Commercial |
$72.78
|
| Rate for Payer: Blue Shield of California Commercial |
$35.42
|
| Rate for Payer: Blue Shield of California Commercial |
$22.14
|
| Rate for Payer: Blue Shield of California Commercial |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$24.80
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Blue Shield of California EPN |
$23.33
|
| Rate for Payer: Blue Shield of California EPN |
$16.33
|
| Rate for Payer: Blue Shield of California EPN |
$24.49
|
| Rate for Payer: Blue Shield of California EPN |
$47.93
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$69.03
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$69.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$39.45
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$83.83
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$59.17
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$78.90
|
| Rate for Payer: Networks By Design Commercial |
$49.31
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$36.03
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$35.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$177.81 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.81
|
| Rate for Payer: Blue Shield of California Commercial |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$177.81 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.81
|
| Rate for Payer: Blue Shield of California Commercial |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
IP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California Commercial |
$71.13
|
| Rate for Payer: Blue Shield of California EPN |
$46.84
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.13
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.44
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Cigna of CA HMO |
$58.63
|
| Rate for Payer: Cigna of CA PPO |
$58.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.20
|
| Rate for Payer: Global Benefits Group Commercial |
$50.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.63
|
| Rate for Payer: Multiplan Commercial |
$67.01
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.88
|
| Rate for Payer: United Healthcare All Other HMO |
$41.88
|
| Rate for Payer: United Healthcare HMO Rider |
$41.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.20
|
| Rate for Payer: Vantage Medical Group Senior |
$71.20
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California Commercial |
$71.13
|
| Rate for Payer: Blue Shield of California EPN |
$46.84
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.13
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.19
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.19
|
| Rate for Payer: United Healthcare All Other HMO |
$48.19
|
| Rate for Payer: United Healthcare HMO Rider |
$48.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.92
|
| Rate for Payer: Vantage Medical Group Senior |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Blue Shield of California Commercial |
$61.81
|
| Rate for Payer: Blue Shield of California EPN |
$40.71
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Cigna of CA HMO |
$58.63
|
| Rate for Payer: Cigna of CA PPO |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.20
|
| Rate for Payer: Global Benefits Group Commercial |
$50.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Multiplan Commercial |
$67.01
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.20
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.19
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.19
|
| Rate for Payer: United Healthcare All Other HMO |
$48.19
|
| Rate for Payer: United Healthcare HMO Rider |
$48.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.92
|
| Rate for Payer: Vantage Medical Group Senior |
$81.92
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$17.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.37 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.94
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$11.64
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.98
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$11.64
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$12.37
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.54
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.37 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$17.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California EPN |
$11.79
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$44.14 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.14
|
| Rate for Payer: Blue Shield of California Commercial |
$19.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.50
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$7.68
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.71
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
|
