|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: Blue Shield of California Commercial |
$28.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.11
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California EPN |
$31.00
|
| Rate for Payer: Blue Shield of California EPN |
$35.14
|
| Rate for Payer: Blue Shield of California EPN |
$20.35
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| 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 |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| 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 Commercial/Self Funded |
$45.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| 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: Multiplan Commercial |
$31.79
|
| Rate for Payer: Multiplan Commercial |
$48.44
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Networks By Design Commercial |
$34.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.01
|
| Rate for Payer: United Healthcare All Other HMO |
$22.33
|
| Rate for Payer: United Healthcare All Other HMO |
$14.66
|
| Rate for Payer: United Healthcare All Other HMO |
$25.31
|
| Rate for Payer: United Healthcare HMO Rider |
$24.77
|
| Rate for Payer: United Healthcare HMO Rider |
$14.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.65
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
IP
|
$112.34
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$95.49 |
| Rate for Payer: Blue Shield of California Commercial |
$79.99
|
| Rate for Payer: Blue Shield of California Commercial |
$90.65
|
| Rate for Payer: Blue Shield of California Commercial |
$56.98
|
| Rate for Payer: Blue Shield of California EPN |
$65.19
|
| Rate for Payer: Blue Shield of California EPN |
$40.98
|
| Rate for Payer: Blue Shield of California EPN |
$57.52
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$89.12
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$89.12
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.93
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$76.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: Multiplan Commercial |
$89.87
|
| Rate for Payer: Multiplan Commercial |
$101.86
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Networks By Design Commercial |
$63.66
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$108.22
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.42
|
| Rate for Payer: United Healthcare All Other HMO |
$46.96
|
| Rate for Payer: United Healthcare All Other HMO |
$41.43
|
| Rate for Payer: United Healthcare All Other HMO |
$29.52
|
| Rate for Payer: United Healthcare HMO Rider |
$28.87
|
| Rate for Payer: United Healthcare HMO Rider |
$40.53
|
| Rate for Payer: United Healthcare HMO Rider |
$45.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.41
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
OP
|
$112.34
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.96 |
| 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 |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.79
|
| 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 |
$48.02
|
| Rate for Payer: Blue Distinction Transplant |
$76.39
|
| Rate for Payer: Blue Distinction Transplant |
$67.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California Commercial |
$82.79
|
| Rate for Payer: Blue Shield of California Commercial |
$58.98
|
| 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 |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA HMO |
$89.12
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$89.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: Dignity Health Media |
$108.22
|
| Rate for Payer: Dignity Health Media |
$95.49
|
| Rate for Payer: Dignity Health Media |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.93
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| Rate for Payer: Global Benefits Group Commercial |
$76.39
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$95.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.93
|
| 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 |
$26.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: Multiplan Commercial |
$101.86
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Multiplan Commercial |
$89.87
|
| Rate for Payer: Networks By Design Commercial |
$63.66
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$108.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.02
|
| Rate for Payer: United Healthcare All Other HMO |
$40.02
|
| Rate for Payer: United Healthcare All Other HMO |
$56.17
|
| Rate for Payer: United Healthcare All Other HMO |
$63.66
|
| Rate for Payer: United Healthcare HMO Rider |
$56.17
|
| Rate for Payer: United Healthcare HMO Rider |
$63.66
|
| Rate for Payer: United Healthcare HMO Rider |
$40.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$108.22
|
| Rate for Payer: Vantage Medical Group Senior |
$95.49
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.95
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
NDG1131A
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.95
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
NDG1131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: Blue Distinction Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: Dignity Health Media |
$0.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.95
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
NDG1131A
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: Blue Distinction Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: Dignity Health Media |
$0.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.95
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
NDG1131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
NDC 43598-426-60
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Blue Shield of California Commercial |
$213.60
|
| Rate for Payer: Blue Shield of California EPN |
$153.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Other HMO |
$110.64
|
| Rate for Payer: United Healthcare HMO Rider |
$108.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
NDC 70860-225-10
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$157.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.99
|
| Rate for Payer: Blue Distinction Transplant |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$176.88
|
| Rate for Payer: Blue Shield of California EPN |
$140.16
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Media |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Other HMO |
$120.00
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
NDC 43598-426-60
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.74
|
| Rate for Payer: Blue Distinction Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$221.10
|
| Rate for Payer: Blue Shield of California EPN |
$175.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Media |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
NDC 63020-049-01
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,057.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.08
|
| Rate for Payer: Blue Distinction Transplant |
$1,154.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,123.38
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Media |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,442.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$1,923.60
|
|
|
Service Code
|
NDC 63020-049-01
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Blue Shield of California Commercial |
$1,369.60
|
| Rate for Payer: Blue Shield of California EPN |
$984.88
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.35
|
| Rate for Payer: United Healthcare All Other HMO |
$709.42
|
| Rate for Payer: United Healthcare HMO Rider |
$694.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.79
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
NDC 70860-225-10
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Blue Shield of California Commercial |
$170.88
|
| Rate for Payer: Blue Shield of California EPN |
$122.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.62
|
| Rate for Payer: United Healthcare All Other HMO |
$88.51
|
| Rate for Payer: United Healthcare HMO Rider |
$86.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.20
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
CPT J9048
|
| Hospital Charge Code |
ERX220799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$1,635.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1,369.59
|
| Rate for Payer: Blue Shield of California EPN |
$984.87
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.43
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.34
|
| Rate for Payer: United Healthcare All Other HMO |
$709.42
|
| Rate for Payer: United Healthcare HMO Rider |
$694.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.78
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
CPT J9048
|
| Hospital Charge Code |
ERX220799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$1,635.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$284.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,123.37
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.82
|
| Rate for Payer: Dignity Health Media |
$48.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.55
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,442.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$79.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$78.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.79
|
| Rate for Payer: United Healthcare HMO Rider |
$961.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.40
|
| Rate for Payer: Vantage Medical Group Senior |
$48.55
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
1755707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,635.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.79
|
| Rate for Payer: Blue Distinction Transplant |
$1,154.16
|
| Rate for Payer: Blue Distinction Transplant |
$1,154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.68
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Media |
$1.96
|
| Rate for Payer: Dignity Health Media |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,442.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.79
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
1755707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$1,635.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1,369.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,369.60
|
| Rate for Payer: Blue Shield of California EPN |
$984.87
|
| Rate for Payer: Blue Shield of California EPN |
$984.88
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.35
|
| Rate for Payer: United Healthcare All Other HMO |
$709.42
|
| Rate for Payer: United Healthcare All Other HMO |
$709.42
|
| Rate for Payer: United Healthcare HMO Rider |
$694.03
|
| Rate for Payer: United Healthcare HMO Rider |
$694.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.79
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
|
IP
|
$1,923.60
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
ERX40835839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Blue Shield of California Commercial |
$1,369.60
|
| Rate for Payer: Blue Shield of California EPN |
$984.88
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.35
|
| Rate for Payer: United Healthcare All Other HMO |
$709.42
|
| Rate for Payer: United Healthcare HMO Rider |
$694.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.79
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
ERX40835839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.79
|
| Rate for Payer: Blue Distinction Transplant |
$1,154.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.69
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Media |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
OP
|
$23.26
|
|
|
Service Code
|
NDC 68382-447-14
|
| Hospital Charge Code |
1710988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.86
|
| Rate for Payer: Blue Distinction Transplant |
$13.96
|
| Rate for Payer: Blue Shield of California Commercial |
$17.14
|
| Rate for Payer: Blue Shield of California EPN |
$13.58
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna of CA HMO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.77
|
| Rate for Payer: Dignity Health Media |
$19.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$19.77
|
| Rate for Payer: Global Benefits Group Commercial |
$13.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$18.61
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Prime Health Services Commercial |
$19.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.63
|
| Rate for Payer: United Healthcare All Other HMO |
$11.63
|
| Rate for Payer: United Healthcare HMO Rider |
$11.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.77
|
| Rate for Payer: Vantage Medical Group Senior |
$19.77
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
IP
|
$23.26
|
|
|
Service Code
|
NDC 68382-447-14
|
| Hospital Charge Code |
1710988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Blue Shield of California Commercial |
$16.56
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna of CA HMO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$19.77
|
| Rate for Payer: Global Benefits Group Commercial |
$13.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$18.61
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Prime Health Services Commercial |
$19.77
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$23.26
|
|
|
Service Code
|
NDC 68382-446-14
|
| Hospital Charge Code |
1710987
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$19.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.86
|
| Rate for Payer: Blue Distinction Transplant |
$13.96
|
| Rate for Payer: Blue Shield of California Commercial |
$17.14
|
| Rate for Payer: Blue Shield of California EPN |
$13.58
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna of CA HMO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.77
|
| Rate for Payer: Dignity Health Media |
$19.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$19.77
|
| Rate for Payer: Global Benefits Group Commercial |
$13.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$18.61
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Prime Health Services Commercial |
$19.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.63
|
| Rate for Payer: United Healthcare All Other HMO |
$11.63
|
| Rate for Payer: United Healthcare HMO Rider |
$11.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.77
|
| Rate for Payer: Vantage Medical Group Senior |
$19.77
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
1710987
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$197.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: Blue Distinction Transplant |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$171.45
|
| Rate for Payer: Blue Shield of California EPN |
$135.86
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cigna of CA HMO |
$162.84
|
| Rate for Payer: Cigna of CA PPO |
$162.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.74
|
| Rate for Payer: Dignity Health Media |
$197.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.05
|
| Rate for Payer: Galaxy Health WC |
$197.74
|
| Rate for Payer: Global Benefits Group Commercial |
$139.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$174.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Multiplan Commercial |
$186.10
|
| Rate for Payer: Networks By Design Commercial |
$151.21
|
| Rate for Payer: Prime Health Services Commercial |
$197.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.32
|
| Rate for Payer: United Healthcare All Other HMO |
$116.32
|
| Rate for Payer: United Healthcare HMO Rider |
$116.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.74
|
| Rate for Payer: Vantage Medical Group Senior |
$197.74
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
IP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
1710987
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$197.74 |
| Rate for Payer: Blue Shield of California Commercial |
$165.63
|
| Rate for Payer: Blue Shield of California EPN |
$119.11
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cigna of CA HMO |
$162.84
|
| Rate for Payer: Cigna of CA PPO |
$162.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.05
|
| Rate for Payer: Galaxy Health WC |
$197.74
|
| Rate for Payer: Global Benefits Group Commercial |
$139.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Multiplan Commercial |
$186.10
|
| Rate for Payer: Networks By Design Commercial |
$151.21
|
| Rate for Payer: Prime Health Services Commercial |
$197.74
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
1710987
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$197.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: Blue Distinction Transplant |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$171.45
|
| Rate for Payer: Blue Shield of California EPN |
$135.86
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cigna of CA HMO |
$162.84
|
| Rate for Payer: Cigna of CA PPO |
$162.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.74
|
| Rate for Payer: Dignity Health Media |
$197.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.05
|
| Rate for Payer: Galaxy Health WC |
$197.74
|
| Rate for Payer: Global Benefits Group Commercial |
$139.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$174.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Multiplan Commercial |
$186.10
|
| Rate for Payer: Networks By Design Commercial |
$151.21
|
| Rate for Payer: Prime Health Services Commercial |
$197.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.32
|
| Rate for Payer: United Healthcare All Other HMO |
$116.32
|
| Rate for Payer: United Healthcare HMO Rider |
$116.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.74
|
| Rate for Payer: Vantage Medical Group Senior |
$197.74
|
|
