|
BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION [214043]
|
Facility
OP
|
$14.15
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG214043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.43
|
| Rate for Payer: BCBS Transplant Transplant |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$10.43
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cigna of CA HMO |
$9.90
|
| Rate for Payer: Cigna of CA PPO |
$9.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Media |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.66
|
| Rate for Payer: Galaxy Health WC |
$12.03
|
| Rate for Payer: Global Benefits Group Commercial |
$8.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$12.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.03
|
| Rate for Payer: Vantage Medical Group Senior |
$12.03
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
IP
|
$27.50
|
|
|
Service Code
|
NDC 50474-570-66
|
| Hospital Charge Code |
ERX214047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$23.38 |
| Rate for Payer: Blue Shield of California Commercial |
$19.58
|
| Rate for Payer: Blue Shield of California EPN |
$14.08
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna of CA HMO |
$19.25
|
| Rate for Payer: Cigna of CA PPO |
$19.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$23.38
|
| Rate for Payer: Global Benefits Group Commercial |
$16.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$22.00
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Prime Health Services Commercial |
$23.38
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
OP
|
$27.50
|
|
|
Service Code
|
NDC 50474-570-66
|
| Hospital Charge Code |
ERX214047
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$23.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.38
|
| Rate for Payer: BCBS Transplant Transplant |
$16.50
|
| Rate for Payer: Blue Shield of California Commercial |
$20.27
|
| Rate for Payer: Blue Shield of California EPN |
$16.06
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna of CA HMO |
$19.25
|
| Rate for Payer: Cigna of CA PPO |
$19.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.38
|
| Rate for Payer: Dignity Health Media |
$23.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$23.38
|
| Rate for Payer: Global Benefits Group Commercial |
$16.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$22.00
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Prime Health Services Commercial |
$23.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.38
|
| Rate for Payer: Vantage Medical Group Senior |
$23.38
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
IP
|
$125.70
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG41146B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$106.84 |
| Rate for Payer: Blue Shield of California Commercial |
$89.50
|
| Rate for Payer: Blue Shield of California Commercial |
$71.60
|
| Rate for Payer: Blue Shield of California Commercial |
$89.49
|
| Rate for Payer: Blue Shield of California EPN |
$51.49
|
| Rate for Payer: Blue Shield of California EPN |
$64.36
|
| Rate for Payer: Blue Shield of California EPN |
$64.35
|
| Rate for Payer: Cash Price |
$56.56
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Cigna of CA HMO |
$87.99
|
| Rate for Payer: Cigna of CA HMO |
$87.98
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$87.98
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$87.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Galaxy Health WC |
$106.84
|
| Rate for Payer: Galaxy Health WC |
$106.84
|
| Rate for Payer: Global Benefits Group Commercial |
$75.41
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Global Benefits Group Commercial |
$75.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$100.55
|
| Rate for Payer: Multiplan Commercial |
$80.45
|
| Rate for Payer: Multiplan Commercial |
$100.56
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Networks By Design Commercial |
$62.84
|
| Rate for Payer: Networks By Design Commercial |
$62.85
|
| Rate for Payer: Prime Health Services Commercial |
$106.84
|
| Rate for Payer: Prime Health Services Commercial |
$106.84
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
OP
|
$125.70
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG41146B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$106.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.13
|
| Rate for Payer: BCBS Transplant Transplant |
$75.41
|
| Rate for Payer: BCBS Transplant Transplant |
$75.42
|
| Rate for Payer: BCBS Transplant Transplant |
$60.34
|
| Rate for Payer: Blue Shield of California Commercial |
$92.63
|
| Rate for Payer: Blue Shield of California Commercial |
$92.64
|
| Rate for Payer: Blue Shield of California Commercial |
$74.11
|
| Rate for Payer: Blue Shield of California EPN |
$58.73
|
| Rate for Payer: Blue Shield of California EPN |
$73.40
|
| Rate for Payer: Blue Shield of California EPN |
$73.41
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Cash Price |
$56.56
|
| Rate for Payer: Cash Price |
$56.56
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$87.98
|
| Rate for Payer: Cigna of CA HMO |
$87.99
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$87.98
|
| Rate for Payer: Cigna of CA PPO |
$87.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.84
|
| Rate for Payer: Dignity Health Media |
$85.48
|
| Rate for Payer: Dignity Health Media |
$106.84
|
| Rate for Payer: Dignity Health Media |
$106.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.28
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Galaxy Health WC |
$106.84
|
| Rate for Payer: Galaxy Health WC |
$106.84
|
| Rate for Payer: Global Benefits Group Commercial |
$75.41
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Global Benefits Group Commercial |
$75.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$100.56
|
| Rate for Payer: Multiplan Commercial |
$100.55
|
| Rate for Payer: Multiplan Commercial |
$80.45
|
| Rate for Payer: Networks By Design Commercial |
$62.84
|
| Rate for Payer: Networks By Design Commercial |
$62.85
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
| Rate for Payer: Prime Health Services Commercial |
$106.84
|
| Rate for Payer: Prime Health Services Commercial |
$106.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.84
|
| Rate for Payer: United Healthcare All Other HMO |
$62.84
|
| Rate for Payer: United Healthcare All Other HMO |
$62.85
|
| Rate for Payer: United Healthcare All Other HMO |
$50.28
|
| Rate for Payer: United Healthcare HMO Rider |
$50.28
|
| Rate for Payer: United Healthcare HMO Rider |
$62.85
|
| Rate for Payer: United Healthcare HMO Rider |
$62.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.84
|
| Rate for Payer: Vantage Medical Group Senior |
$106.84
|
| Rate for Payer: Vantage Medical Group Senior |
$85.48
|
| Rate for Payer: Vantage Medical Group Senior |
$106.84
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
IP
|
$3.97
|
|
|
Service Code
|
NDC 63304-962-30
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
IP
|
$3.97
|
|
|
Service Code
|
NDC 0574-0106-03
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
OP
|
$3.97
|
|
|
Service Code
|
NDC 0574-0106-03
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.37
|
| Rate for Payer: BCBS Transplant Transplant |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Media |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
OP
|
$6.02
|
|
|
Service Code
|
NDC 0781-5325-31
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: BCBS Transplant Transplant |
$3.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.21
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.12
|
| Rate for Payer: Dignity Health Media |
$5.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$3.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.91
|
| Rate for Payer: Prime Health Services Commercial |
$5.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$3.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
OP
|
$3.97
|
|
|
Service Code
|
NDC 63304-962-30
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.37
|
| Rate for Payer: BCBS Transplant Transplant |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Media |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
IP
|
$6.02
|
|
|
Service Code
|
NDC 0781-5325-31
|
| Hospital Charge Code |
1710748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.21
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.91
|
| Rate for Payer: Prime Health Services Commercial |
$5.12
|
|
|
BROMPHENIRAMINE-PHENYLEPHRINE 1 MG-2.5 MG/5 ML ORAL SOLUTION [77434]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 49348-777-34
|
| Hospital Charge Code |
NDG77434
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
BROMPHENIRAMINE-PHENYLEPHRINE 1 MG-2.5 MG/5 ML ORAL SOLUTION [77434]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 49348-777-34
|
| Hospital Charge Code |
NDG77434
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
IP
|
$22,077.81
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$16,936.00 |
| Max. Negotiated Rate |
$22,077.81 |
| Rate for Payer: IEHP Medi-Cal |
$16,936.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,077.81
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
IP
|
$10,385.38
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$7,966.68 |
| Max. Negotiated Rate |
$10,385.38 |
| Rate for Payer: IEHP Medi-Cal |
$7,966.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,385.38
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
IP
|
$6,556.48
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$5,029.51 |
| Max. Negotiated Rate |
$6,556.48 |
| Rate for Payer: IEHP Medi-Cal |
$5,029.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,556.48
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
IP
|
$4,577.31
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$3,511.28 |
| Max. Negotiated Rate |
$4,577.31 |
| Rate for Payer: IEHP Medi-Cal |
$3,511.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,577.31
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 31622
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 31624
|
| Min. Negotiated Rate |
$405.33 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 31635
|
| Min. Negotiated Rate |
$396.13 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
NDC 69097-318-86
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: BCBS Transplant Transplant |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Media |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
NDC 69097-318-87
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: BCBS Transplant Transplant |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Media |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
NDC 0487-9601-01
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: BCBS Transplant Transplant |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$15.03
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Media |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
IP
|
$4.52
|
|
|
Service Code
|
NDC 0093-6815-73
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
NDC 0487-9601-01
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Blue Shield of California Commercial |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$10.44
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
|
