|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 55150-221-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
NDC 67457-902-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Media |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 67457-902-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 55150-221-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Media |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
IP
|
$1,310.98
|
|
|
Service Code
|
CPT J7307
|
| Hospital Charge Code |
ERX77012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.64 |
| Max. Negotiated Rate |
$1,114.33 |
| Rate for Payer: Blue Shield of California Commercial |
$933.42
|
| Rate for Payer: Blue Shield of California EPN |
$671.22
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cigna of CA HMO |
$917.69
|
| Rate for Payer: Cigna of CA PPO |
$917.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$524.39
|
| Rate for Payer: Galaxy Health WC |
$1,114.33
|
| Rate for Payer: Global Benefits Group Commercial |
$786.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$874.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.64
|
| Rate for Payer: Multiplan Commercial |
$1,048.78
|
| Rate for Payer: Networks By Design Commercial |
$655.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,114.33
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
OP
|
$1,310.98
|
|
|
Service Code
|
CPT J7307
|
| Hospital Charge Code |
ERX77012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.64 |
| Max. Negotiated Rate |
$6,803.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,803.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,114.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$721.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$721.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,161.17
|
| Rate for Payer: BCBS Transplant Transplant |
$786.59
|
| Rate for Payer: Blue Shield of California Commercial |
$966.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,177.87
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cigna of CA HMO |
$917.69
|
| Rate for Payer: Cigna of CA PPO |
$917.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,114.33
|
| Rate for Payer: Dignity Health Media |
$1,114.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,114.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$524.39
|
| Rate for Payer: Galaxy Health WC |
$1,114.33
|
| Rate for Payer: Global Benefits Group Commercial |
$786.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$983.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$874.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.64
|
| Rate for Payer: Multiplan Commercial |
$1,048.78
|
| Rate for Payer: Networks By Design Commercial |
$655.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,114.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.49
|
| Rate for Payer: United Healthcare All Other HMO |
$655.49
|
| Rate for Payer: United Healthcare HMO Rider |
$655.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,114.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,114.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1,114.33
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.25
|
|
|
Service Code
|
NDC 68001-265-25
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-05
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-01
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-01
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.25
|
|
|
Service Code
|
NDC 68001-265-25
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: BCBS Transplant Transplant |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: Dignity Health Media |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-31
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.47
|
| Rate for Payer: BCBS Transplant Transplant |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Media |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-05
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.47
|
| Rate for Payer: BCBS Transplant Transplant |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Media |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-31
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
OP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$150.89 |
| Rate for Payer: IEHP Medicare Advantage |
$76.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.61
|
| Rate for Payer: BCBS Transplant Transplant |
$54.24
|
| Rate for Payer: Blue Shield of California Commercial |
$66.62
|
| Rate for Payer: Blue Shield of California EPN |
$90.40
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.92
|
| Rate for Payer: Dignity Health Media |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.61
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.64
|
| Rate for Payer: IEHP Medi-Cal |
$124.11
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$124.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.66
|
| Rate for Payer: Multiplan Commercial |
$72.32
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.20
|
| Rate for Payer: United Healthcare All Other HMO |
$45.20
|
| Rate for Payer: United Healthcare HMO Rider |
$45.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: Vantage Medical Group Senior |
$76.61
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
IP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Blue Shield of California Commercial |
$64.36
|
| Rate for Payer: Blue Shield of California EPN |
$46.28
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.16
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$72.32
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
IP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.52
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$11.75
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
OP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.75
|
| Rate for Payer: BCBS Transplant Transplant |
$8.81
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.58
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: Dignity Health Media |
$12.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$11.75
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
OP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.50
|
| Rate for Payer: BCBS Transplant Transplant |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$21.65
|
| Rate for Payer: Blue Shield of California EPN |
$17.15
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.96
|
| Rate for Payer: Dignity Health Media |
$24.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$23.50
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.68
|
| Rate for Payer: United Healthcare All Other HMO |
$14.68
|
| Rate for Payer: United Healthcare HMO Rider |
$14.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.96
|
| Rate for Payer: Vantage Medical Group Senior |
$24.96
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
IP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.04
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$23.50
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: BCBS Transplant Transplant |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$26.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Media |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.20
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
