|
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: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| 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
|
$0.01
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| 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
|
|
|
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: BCBS Transplant Transplant |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.94
|
| 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
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
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 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: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
| 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
|
|
|
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
|
|
|
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 |
$43.98
|
| Rate for Payer: Blue Shield of California EPN |
$89.09
|
| 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 |
$34.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$73.02
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| 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 |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.30
|
| 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 |
$73.02
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
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: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| 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 |
$121.80
|
| Rate for Payer: Cigna of CA PPO |
$60.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$51.54
|
| Rate for Payer: BCBS Transplant 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: Dignity Health Commercial/Exchange |
$73.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| 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 |
$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 |
$73.02
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$51.54
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.50
|
| 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 |
$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 |
$42.95
|
| Rate for Payer: Networks By Design Commercial |
$87.00
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.54
|
| 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 |
$42.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.00
|
| 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 |
$73.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.90
|
| 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 |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$73.02
|
|
|
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 |
$30.89
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| 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 |
$23.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Multiplan Commercial |
$48.44
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Networks By Design Commercial |
$34.32
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
OP
|
$68.64
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.47 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$37.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.30
|
| 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: BCBS Transplant Transplant |
$36.33
|
| Rate for Payer: BCBS Transplant Transplant |
$23.84
|
| Rate for Payer: BCBS Transplant Transplant |
$41.18
|
| Rate for Payer: Blue Shield of California Commercial |
$29.29
|
| Rate for Payer: Blue Shield of California Commercial |
$44.63
|
| 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 |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| 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: Dignity Health Commercial/Exchange |
$51.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.78
|
| Rate for Payer: Dignity Health Media |
$58.34
|
| Rate for Payer: Dignity Health Media |
$51.47
|
| Rate for Payer: Dignity Health Media |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$51.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.80
|
| 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 |
$16.47
|
| 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: 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 |
$34.32
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$23.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.32
|
| Rate for Payer: United Healthcare All Other HMO |
$30.28
|
| Rate for Payer: United Healthcare All Other HMO |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$34.32
|
| Rate for Payer: United Healthcare HMO Rider |
$30.28
|
| Rate for Payer: United Healthcare HMO Rider |
$19.87
|
| Rate for Payer: United Healthcare HMO Rider |
$34.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.32
|
| 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 |
$58.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$108.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.02
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$76.39
|
| Rate for Payer: BCBS Transplant Transplant |
$67.40
|
| Rate for Payer: BCBS Transplant Transplant |
$48.02
|
| 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 |
$57.29
|
| Rate for Payer: Cash Price |
$57.29
|
| 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 |
$36.01
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA HMO |
$89.12
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| 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: 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 |
$95.49
|
| Rate for Payer: Dignity Health Media |
$68.03
|
| Rate for Payer: Dignity Health Media |
$108.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.49
|
| 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 |
$50.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$84.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$60.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$95.49
|
| 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 |
$89.87
|
| 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 |
$108.22
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.39
|
| 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: TriValley Medical Group Commercial/Senior |
$76.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.17
|
| 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 All Other HMO |
$40.02
|
| 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 |
$63.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.22
|
| 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
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
IP
|
$80.03
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Blue Shield of California Commercial |
$56.98
|
| 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 EPN |
$40.98
|
| Rate for Payer: Blue Shield of California EPN |
$65.19
|
| Rate for Payer: Blue Shield of California EPN |
$57.52
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$36.01
|
| 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 |
$89.12
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| 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 |
$50.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$76.39
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.93
|
| 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 |
$26.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Multiplan Commercial |
$101.86
|
| Rate for Payer: Multiplan Commercial |
$89.87
|
| 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 |
$108.22
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Prime Health Services Commercial |
$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: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
