|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
NDC 50242-060-01
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$203.22 |
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.38
|
| Rate for Payer: Multiplan Commercial |
$191.26
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
NDC4081093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$203.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.44
|
| Rate for Payer: Blue Distinction Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$176.20
|
| Rate for Payer: Blue Shield of California EPN |
$139.62
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cigna of CA HMO |
$153.01
|
| Rate for Payer: Cigna of CA PPO |
$176.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.22
|
| Rate for Payer: Dignity Health Media |
$203.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$179.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.38
|
| Rate for Payer: Multiplan Commercial |
$191.26
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.54
|
| Rate for Payer: United Healthcare All Other HMO |
$119.54
|
| Rate for Payer: United Healthcare HMO Rider |
$119.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.22
|
| Rate for Payer: Vantage Medical Group Senior |
$203.22
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
NDC 55513-206-01
|
| Hospital Charge Code |
NDG225272A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$177.92 |
| Rate for Payer: Blue Shield of California Commercial |
$149.04
|
| Rate for Payer: Blue Shield of California EPN |
$107.17
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.24
|
| Rate for Payer: Multiplan Commercial |
$167.46
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.04
|
| Rate for Payer: United Healthcare All Other HMO |
$77.20
|
| Rate for Payer: United Healthcare HMO Rider |
$75.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.08
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
NDC 55513-206-01
|
| Hospital Charge Code |
NDG225272A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$177.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.71
|
| Rate for Payer: Blue Distinction Transplant |
$125.59
|
| Rate for Payer: Blue Shield of California Commercial |
$154.27
|
| Rate for Payer: Blue Shield of California EPN |
$122.24
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.92
|
| Rate for Payer: Dignity Health Media |
$177.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$156.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.24
|
| Rate for Payer: Multiplan Commercial |
$167.46
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.66
|
| Rate for Payer: United Healthcare All Other HMO |
$104.66
|
| Rate for Payer: United Healthcare HMO Rider |
$104.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.92
|
| Rate for Payer: Vantage Medical Group Senior |
$177.92
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
NDC 55513-207-01
|
| Hospital Charge Code |
NDG225272B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$177.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.71
|
| Rate for Payer: Blue Distinction Transplant |
$125.59
|
| Rate for Payer: Blue Shield of California Commercial |
$154.27
|
| Rate for Payer: Blue Shield of California EPN |
$122.24
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.92
|
| Rate for Payer: Dignity Health Media |
$177.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$156.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.24
|
| Rate for Payer: Multiplan Commercial |
$167.46
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.66
|
| Rate for Payer: United Healthcare All Other HMO |
$104.66
|
| Rate for Payer: United Healthcare HMO Rider |
$104.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$177.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.92
|
| Rate for Payer: Vantage Medical Group Senior |
$177.92
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
NDC 55513-207-01
|
| Hospital Charge Code |
NDG225272B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$177.92 |
| Rate for Payer: Blue Shield of California Commercial |
$149.04
|
| Rate for Payer: Blue Shield of California EPN |
$107.17
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.24
|
| Rate for Payer: Multiplan Commercial |
$167.46
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.04
|
| Rate for Payer: United Healthcare All Other HMO |
$77.20
|
| Rate for Payer: United Healthcare HMO Rider |
$75.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.08
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT J0565
|
| Hospital Charge Code |
NDG216412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Shield of California Commercial |
$81.17
|
| Rate for Payer: Blue Shield of California EPN |
$58.37
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.05
|
| Rate for Payer: United Healthcare All Other HMO |
$42.04
|
| Rate for Payer: United Healthcare HMO Rider |
$41.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.62
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT J0565
|
| Hospital Charge Code |
NDG216412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$250.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$250.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.96
|
| Rate for Payer: Blue Distinction Transplant |
$68.40
|
| Rate for Payer: Blue Shield of California Commercial |
$84.02
|
| Rate for Payer: Blue Shield of California EPN |
$45.60
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.79
|
| Rate for Payer: Dignity Health Media |
$39.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.86
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$65.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$64.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.41
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.84
|
| Rate for Payer: Vantage Medical Group Senior |
$39.86
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Distinction Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: Blue Distinction Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Media |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6019-46
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Distinction Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Media |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
1710869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
1771296
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| 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: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
1771296
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
NDG121260
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| 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: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
NDG121260
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT A4706
|
| Hospital Charge Code |
NDG120070
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT A4706
|
| Hospital Charge Code |
NDG120070
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.71
|
| 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: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-105-06
|
| Hospital Charge Code |
1771276
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| 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: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-105-06
|
| Hospital Charge Code |
1771276
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.00
|
| 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
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
OP
|
$151.81
|
|
|
Service Code
|
NDC 61958-2501-1
|
| Hospital Charge Code |
ERX221141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.45
|
| Rate for Payer: Blue Distinction Transplant |
$91.09
|
| Rate for Payer: Blue Shield of California Commercial |
$111.88
|
| Rate for Payer: Blue Shield of California EPN |
$88.66
|
| Rate for Payer: Cash Price |
$68.31
|
| Rate for Payer: Cigna of CA HMO |
$106.27
|
| Rate for Payer: Cigna of CA PPO |
$106.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.04
|
| Rate for Payer: Dignity Health Media |
$129.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.72
|
| Rate for Payer: Galaxy Health WC |
$129.04
|
| Rate for Payer: Global Benefits Group Commercial |
$91.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$113.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$121.45
|
| Rate for Payer: Networks By Design Commercial |
$98.68
|
| Rate for Payer: Prime Health Services Commercial |
$129.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.90
|
| Rate for Payer: United Healthcare All Other HMO |
$75.90
|
| Rate for Payer: United Healthcare HMO Rider |
$75.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.04
|
| Rate for Payer: Vantage Medical Group Senior |
$129.04
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
IP
|
$151.81
|
|
|
Service Code
|
NDC 61958-2501-1
|
| Hospital Charge Code |
ERX221141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Blue Shield of California Commercial |
$108.09
|
| Rate for Payer: Blue Shield of California EPN |
$77.73
|
| Rate for Payer: Cash Price |
$68.31
|
| Rate for Payer: Cigna of CA HMO |
$106.27
|
| Rate for Payer: Cigna of CA PPO |
$106.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: Galaxy Health WC |
$129.04
|
| Rate for Payer: Global Benefits Group Commercial |
$91.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$121.45
|
| Rate for Payer: Networks By Design Commercial |
$98.68
|
| Rate for Payer: Prime Health Services Commercial |
$129.04
|
|
|
BIMATOPROST 0.01 % EYE DROPS [105410]
|
Facility
|
IP
|
$114.92
|
|
|
Service Code
|
NDC 0023-3205-03
|
| Hospital Charge Code |
NDG105410
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.58 |
| Max. Negotiated Rate |
$97.68 |
| Rate for Payer: Blue Shield of California Commercial |
$81.82
|
| Rate for Payer: Blue Shield of California EPN |
$58.84
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Cigna of CA HMO |
$80.44
|
| Rate for Payer: Cigna of CA PPO |
$80.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.97
|
| Rate for Payer: Galaxy Health WC |
$97.68
|
| Rate for Payer: Global Benefits Group Commercial |
$68.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.58
|
| Rate for Payer: Multiplan Commercial |
$91.94
|
| Rate for Payer: Networks By Design Commercial |
$74.70
|
| Rate for Payer: Prime Health Services Commercial |
$97.68
|
|
