|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [206243]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX206243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Media |
$2.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.74
|
| Rate for Payer: IEHP Medi-Cal |
$3.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
OP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Media |
$2.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.74
|
| Rate for Payer: IEHP Medi-Cal |
$3.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.28
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
IP
|
$3.58
|
|
|
Service Code
|
CPT J7168
|
| Hospital Charge Code |
ERX205938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
OP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$40.18
|
| Rate for Payer: Blue Shield of California Commercial |
$49.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: Dignity Health Media |
$56.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$50.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$33.48
|
| Rate for Payer: United Healthcare HMO Rider |
$33.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
IP
|
$66.96
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
1721178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Blue Shield of California Commercial |
$47.68
|
| Rate for Payer: Blue Shield of California EPN |
$34.28
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
IP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$102.71 |
| Rate for Payer: Blue Shield of California Commercial |
$86.03
|
| Rate for Payer: Blue Shield of California EPN |
$61.86
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cigna of CA HMO |
$84.58
|
| Rate for Payer: Cigna of CA PPO |
$84.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.33
|
| Rate for Payer: Galaxy Health WC |
$102.71
|
| Rate for Payer: Global Benefits Group Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$96.66
|
| Rate for Payer: Networks By Design Commercial |
$60.42
|
| Rate for Payer: Prime Health Services Commercial |
$102.71
|
|
|
HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]
|
Facility
OP
|
$120.83
|
|
|
Service Code
|
CPT J3471
|
| Hospital Charge Code |
1721153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$102.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$72.50
|
| Rate for Payer: Blue Shield of California Commercial |
$89.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cash Price |
$54.37
|
| Rate for Payer: Cigna of CA HMO |
$84.58
|
| Rate for Payer: Cigna of CA PPO |
$84.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.71
|
| Rate for Payer: Dignity Health Media |
$102.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.33
|
| Rate for Payer: Galaxy Health WC |
$102.71
|
| Rate for Payer: Global Benefits Group Commercial |
$72.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$96.66
|
| Rate for Payer: Networks By Design Commercial |
$60.42
|
| Rate for Payer: Prime Health Services Commercial |
$102.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.42
|
| Rate for Payer: United Healthcare All Other HMO |
$60.42
|
| Rate for Payer: United Healthcare HMO Rider |
$60.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.71
|
| Rate for Payer: Vantage Medical Group Senior |
$102.71
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-03
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 23155-001-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 23155-001-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
NDC 68084-447-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
NDC 68084-447-11
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.13
|
|
|
Service Code
|
NDC 0904-6440-61
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
NDC 68084-447-11
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.13
|
|
|
Service Code
|
NDC 0904-6440-61
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-20
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-20
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
NDC 68084-447-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-03
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-01
|
| Hospital Charge Code |
1711080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]
|
Facility
OP
|
$14.40
|
|
|
Service Code
|
CPT J0360
|
| Hospital Charge Code |
1720072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.20
|
| Rate for Payer: BCBS Transplant Transplant |
$30.57
|
| Rate for Payer: BCBS Transplant Transplant |
$8.64
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$10.31
|
| Rate for Payer: Blue Shield of California Commercial |
$12.66
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$37.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10.61
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$12.03
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$35.66
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$35.66
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$43.31
|
| Rate for Payer: Dignity Health Media |
$14.60
|
| Rate for Payer: Dignity Health Media |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.38
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$43.31
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$14.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$30.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$40.76
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Networks By Design Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$43.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$25.48
|
| Rate for Payer: United Healthcare HMO Rider |
$25.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$43.31
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT J0360
|
| Hospital Charge Code |
1720072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$35.66
|
| Rate for Payer: Cigna of CA PPO |
$35.66
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$43.31
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$36.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$12.23
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$26.09
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$12.03
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.57
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$40.76
|
| Rate for Payer: Multiplan Commercial |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$43.31
|
|
