|
BISMUTH SUBSALICYLATE 262 MG TABLET [9174]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 37000-476-03
|
| Hospital Charge Code |
1712549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [9174]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 149003991
|
| Hospital Charge Code |
1712549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [9174]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 149003991
|
| Hospital Charge Code |
1712549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [9174]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 37000-476-03
|
| Hospital Charge Code |
1712549
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 46122-639-34
|
| Hospital Charge Code |
NDG112159A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 37000-019-01
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 46122-639-34
|
| Hospital Charge Code |
NDG112159A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| 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: Cash Price |
$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 |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 149003930
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 37000-019-01
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 149003930
|
| Hospital Charge Code |
NDG112159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0536-1287-36
|
| Hospital Charge Code |
NDG112159A
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION [112159]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0536-1287-36
|
| Hospital Charge Code |
NDG112159A
|
|
Hospital Revenue Code
|
259
|
| 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: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$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
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-30
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Media |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-30
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 60687-679-11
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 60687-679-11
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Distinction Transplant |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Media |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Media |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-10
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-13
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Media |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-13
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 52817-270-10
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Media |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
ERX18288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
|
OP
|
$85.90
|
|
|
Service Code
|
CPT J0583
|
| Hospital Charge Code |
1722040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$73.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Blue Distinction Transplant |
$51.54
|
| Rate for Payer: Blue Distinction Transplant |
$104.40
|
| Rate for Payer: Blue Shield of California Commercial |
$128.24
|
| Rate for Payer: Blue Shield of California Commercial |
$63.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna of CA HMO |
$60.13
|
| Rate for Payer: Cigna of CA HMO |
$121.80
|
| Rate for Payer: Cigna of CA PPO |
$60.13
|
| Rate for Payer: Cigna of CA PPO |
$121.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.02
|
| Rate for Payer: Dignity Health Media |
$73.02
|
| Rate for Payer: Dignity Health Media |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.36
|
| Rate for Payer: Galaxy Health WC |
$73.02
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Global Benefits Group Commercial |
$51.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$130.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$68.72
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$42.95
|
| Rate for Payer: Prime Health Services Commercial |
$73.02
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.95
|
| Rate for Payer: United Healthcare All Other HMO |
$42.95
|
| Rate for Payer: United Healthcare All Other HMO |
$87.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42.95
|
| Rate for Payer: United Healthcare HMO Rider |
$87.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.02
|
| Rate for Payer: Vantage Medical Group Senior |
$73.02
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT J0583
|
| Hospital Charge Code |
1722040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Blue Shield of California Commercial |
$123.89
|
| Rate for Payer: Blue Shield of California Commercial |
$61.16
|
| Rate for Payer: Blue Shield of California EPN |
$89.09
|
| Rate for Payer: Blue Shield of California EPN |
$43.98
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna of CA HMO |
$121.80
|
| Rate for Payer: Cigna of CA HMO |
$60.13
|
| Rate for Payer: Cigna of CA PPO |
$60.13
|
| Rate for Payer: Cigna of CA PPO |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.36
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$73.02
|
| Rate for Payer: Global Benefits Group Commercial |
$51.54
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$68.72
|
| Rate for Payer: Networks By Design Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$42.95
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.44
|
| Rate for Payer: United Healthcare All Other HMO |
$64.17
|
| Rate for Payer: United Healthcare All Other HMO |
$31.68
|
| Rate for Payer: United Healthcare HMO Rider |
$62.78
|
| Rate for Payer: United Healthcare HMO Rider |
$30.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.35
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$577.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.20
|
| Rate for Payer: Blue Distinction Transplant |
$41.18
|
| Rate for Payer: Blue Distinction Transplant |
$36.33
|
| Rate for Payer: Blue Distinction Transplant |
$23.84
|
| Rate for Payer: Blue Shield of California Commercial |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$29.29
|
| Rate for Payer: Blue Shield of California Commercial |
$50.59
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Media |
$51.47
|
| Rate for Payer: Dignity Health Media |
$33.78
|
| Rate for Payer: Dignity Health Media |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.22
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.44
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Networks By Design Commercial |
$34.32
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.32
|
| Rate for Payer: United Healthcare All Other HMO |
$34.32
|
| Rate for Payer: United Healthcare All Other HMO |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$30.28
|
| Rate for Payer: United Healthcare HMO Rider |
$19.87
|
| Rate for Payer: United Healthcare HMO Rider |
$30.28
|
| Rate for Payer: United Healthcare HMO Rider |
$34.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
