|
GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT [16254]
|
Facility
|
OP
|
$2,897.47
|
|
|
Service Code
|
CPT J9202
|
| Hospital Charge Code |
1755728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.01 |
| Max. Negotiated Rate |
$2,462.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,199.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,738.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,135.44
|
| Rate for Payer: Blue Shield of California EPN |
$837.77
|
| Rate for Payer: Cash Price |
$1,303.86
|
| Rate for Payer: Cash Price |
$1,303.86
|
| Rate for Payer: Cigna of CA HMO |
$2,028.23
|
| Rate for Payer: Cigna of CA PPO |
$2,028.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$913.51
|
| Rate for Payer: Dignity Health Media |
$609.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$609.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$609.01
|
| Rate for Payer: Galaxy Health WC |
$2,462.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,738.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,173.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$998.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$998.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$986.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$986.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$609.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,932.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$767.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$816.07
|
| Rate for Payer: Multiplan Commercial |
$2,317.98
|
| Rate for Payer: Networks By Design Commercial |
$1,448.74
|
| Rate for Payer: Prime Health Services Commercial |
$2,462.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,738.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,738.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,448.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,448.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,448.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,448.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$913.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.91
|
| Rate for Payer: Vantage Medical Group Senior |
$609.01
|
|
|
GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT [16254]
|
Facility
|
IP
|
$2,897.47
|
|
|
Service Code
|
CPT J9202
|
| Hospital Charge Code |
1755728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$695.39 |
| Max. Negotiated Rate |
$2,462.85 |
| Rate for Payer: Blue Shield of California Commercial |
$2,063.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,483.50
|
| Rate for Payer: Cash Price |
$1,303.86
|
| Rate for Payer: Cigna of CA HMO |
$2,028.23
|
| Rate for Payer: Cigna of CA PPO |
$2,028.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,158.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,158.99
|
| Rate for Payer: Galaxy Health WC |
$2,462.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,738.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,932.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.39
|
| Rate for Payer: Multiplan Commercial |
$2,317.98
|
| Rate for Payer: Networks By Design Commercial |
$1,448.74
|
| Rate for Payer: Prime Health Services Commercial |
$2,462.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.59
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$956.17
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT [10137]
|
Facility
|
OP
|
$1,033.43
|
|
|
Service Code
|
CPT J9202
|
| Hospital Charge Code |
1755721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.02 |
| Max. Negotiated Rate |
$1,199.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,199.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.69
|
| Rate for Payer: Blue Distinction Transplant |
$620.06
|
| Rate for Payer: Blue Shield of California Commercial |
$761.64
|
| Rate for Payer: Blue Shield of California EPN |
$837.77
|
| Rate for Payer: Cash Price |
$465.04
|
| Rate for Payer: Cash Price |
$465.04
|
| Rate for Payer: Cigna of CA HMO |
$723.40
|
| Rate for Payer: Cigna of CA PPO |
$723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$913.51
|
| Rate for Payer: Dignity Health Media |
$609.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$609.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$609.01
|
| Rate for Payer: Galaxy Health WC |
$878.42
|
| Rate for Payer: Global Benefits Group Commercial |
$620.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$775.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$998.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$998.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$986.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$986.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$609.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$767.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$816.07
|
| Rate for Payer: Multiplan Commercial |
$826.74
|
| Rate for Payer: Networks By Design Commercial |
$516.72
|
| Rate for Payer: Prime Health Services Commercial |
$878.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$620.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$620.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.72
|
| Rate for Payer: United Healthcare All Other HMO |
$516.72
|
| Rate for Payer: United Healthcare HMO Rider |
$516.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$913.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.91
|
| Rate for Payer: Vantage Medical Group Senior |
$609.01
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT [10137]
|
Facility
|
IP
|
$1,033.43
|
|
|
Service Code
|
CPT J9202
|
| Hospital Charge Code |
1755721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.02 |
| Max. Negotiated Rate |
$878.42 |
| Rate for Payer: Blue Shield of California Commercial |
$735.80
|
| Rate for Payer: Blue Shield of California EPN |
$529.12
|
| Rate for Payer: Cash Price |
$465.04
|
| Rate for Payer: Cigna of CA HMO |
$723.40
|
| Rate for Payer: Cigna of CA PPO |
$723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$413.37
|
| Rate for Payer: Galaxy Health WC |
$878.42
|
| Rate for Payer: Global Benefits Group Commercial |
$620.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.02
|
| Rate for Payer: Multiplan Commercial |
$826.74
|
| Rate for Payer: Networks By Design Commercial |
$516.72
|
| Rate for Payer: Prime Health Services Commercial |
$878.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.22
|
| Rate for Payer: United Healthcare All Other HMO |
$381.13
|
| Rate for Payer: United Healthcare HMO Rider |
$372.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$341.03
|
|
|
Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)
|
Facility
|
OP
|
$11,999.72
|
|
|
Service Code
|
CPT 21235
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$11,999.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 15773
|
| Min. Negotiated Rate |
$985.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,691.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,691.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [12552]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
CPT J1626
|
| Hospital Charge Code |
NDG12552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California Commercial |
$16.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$15.85
|
| Rate for Payer: Cigna of CA PPO |
$15.85
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.06
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$8.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.47
|
|
|
GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [12552]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
CPT J1626
|
| Hospital Charge Code |
NDG12552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.75
|
| Rate for Payer: Blue Distinction Transplant |
$6.48
|
| Rate for Payer: Blue Distinction Transplant |
$13.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$16.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$15.85
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$15.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Media |
$19.24
|
| Rate for Payer: Dignity Health Media |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.06
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.32
|
| Rate for Payer: United Healthcare All Other HMO |
$11.32
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$11.32
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
GRANISETRON HCL 1 MG/ML INTRAVENOUS SOLUTION [92107]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
CPT J1626
|
| Hospital Charge Code |
NDG92107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.75
|
| Rate for Payer: Blue Distinction Transplant |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Media |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
GRANISETRON HCL 1 MG/ML INTRAVENOUS SOLUTION [92107]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
CPT J1626
|
| Hospital Charge Code |
NDG92107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
|
|
GRANISETRON HCL 1 MG TABLET [14720]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 51991-735-20
|
| Hospital Charge Code |
1712186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
GRANISETRON HCL 1 MG TABLET [14720]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 51991-735-99
|
| Hospital Charge Code |
1712186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
GRANISETRON HCL 1 MG TABLET [14720]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 51991-735-20
|
| Hospital Charge Code |
1712186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
|
GRANISETRON HCL 1 MG TABLET [14720]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 51991-735-99
|
| Hospital Charge Code |
1712186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
|
GREEN GODDESS COMPOUND OS/UD [4082278]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 9994-0822-78
|
| Hospital Charge Code |
NDG4082722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
GREEN GODDESS COMPOUND OS/UD [4082278]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 9994-0822-78
|
| Hospital Charge Code |
NDG4082722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Distinction Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Media |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
GREEN GODDESS (HYOSCYAMINE) COMPOUND BULK [40802780]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 99408-027-80
|
| Hospital Charge Code |
1717093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
GREEN GODDESS (HYOSCYAMINE) COMPOUND BULK [40802780]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 99408-027-80
|
| Hospital Charge Code |
1717093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
GREEN GODDESS(HYOSCYAMINE) COMPOUND OS/UD [40822780]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 9940-8227-80
|
| Hospital Charge Code |
NDC4082278B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
GREEN GODDESS(HYOSCYAMINE) COMPOUND OS/UD [40822780]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 9940-8227-80
|
| Hospital Charge Code |
NDC4082278B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 9999-3542-00
|
| Hospital Charge Code |
1716015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 9999-3542-00
|
| Hospital Charge Code |
1716015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 50383-063-05
|
| Hospital Charge Code |
1716015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 50383-063-05
|
| Hospital Charge Code |
1716015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 0121-1744-05
|
| Hospital Charge Code |
1716015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
