|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.99
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.74
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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: AlphaCare Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant 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
|
$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
|
|
|
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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$60.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.67
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$78.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$78.65
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,154.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,417.69
|
| 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 |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| 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 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 |
$1,635.06
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| 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 Transplant Other |
$1,442.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: IEHP Medi-Cal |
$3.17
|
| Rate for Payer: IEHP Medi-Cal |
$3.17
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.17
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.17
|
| Rate for Payer: IEHP Medicare Advantage |
$1.96
|
| Rate for Payer: 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 Commercial/Self Funded |
$1,283.03
|
| 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 |
$1,538.88
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| 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 |
$1,635.06
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| 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 |
$961.79
|
| 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 All Other HMO |
$961.79
|
| 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 |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.79
|
| 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 |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| 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 |
$1,154.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| 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 |
$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 |
$1,538.88
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| 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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.79
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$3.17
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.17
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.86
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$13.96
|
| 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
IP
|
$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: 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
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
IP
|
$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: 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$139.58
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$19.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.86
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$13.96
|
| 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: Galaxy Health WC |
$197.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$139.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$139.58
|
| 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 CRUSHED TABLET IN WATER [40831875]
|
Facility
OP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
ERX40831875
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$139.58
|
| 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 CRUSHED TABLET IN WATER [40831875]
|
Facility
IP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
ERX40831875
|
|
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 CRUSHED TABLET IN WATER [40831875]
|
Facility
IP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
ERX40831875
|
|
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 CRUSHED TABLET IN WATER [40831875]
|
Facility
OP
|
$232.63
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
ERX40831875
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$197.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$139.58
|
| 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 ORAL SUSPENSION COMPOUND 6.25MG/ML [40831876]
|
Facility
OP
|
$16.44
|
|
|
Service Code
|
NDC 9940-8318-76
|
| Hospital Charge Code |
NDC40831876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.79
|
| Rate for Payer: BCBS Transplant Transplant |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$12.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.60
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cigna of CA HMO |
$11.51
|
| Rate for Payer: Cigna of CA PPO |
$11.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.97
|
| Rate for Payer: Dignity Health Media |
$13.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.97
|
| Rate for Payer: Vantage Medical Group Senior |
$13.97
|
|
